Palace of Care – Ready To Go

Photo by Andrew Neel on Unsplash

He didn’t look too bad. He had lost weight from the time I had last seen him which was about six weeks ago. He was a bit slower to answer questions and he looked exhausted, but he didn’t look all that different. The lower leg ulcer looked worse, he had also developed a skin infection in his hip. He made it very clear to me that he did not want the infections to be treated. He did not want to go back into the hospital. He knew that untreated infection could lead to death. That’s what he wanted. He wanted to die as he felt he did not want to continue living after almost ten years of worsening pain. A decade of decreased function, of being unable to do the things he liked. He had been an active grandfather previously but he couldn’t do a lot of the things he loved to do with his grandchildren. Walking was difficult at times and he was worried about how his family were doing as he knew looking after him took a toll on them. He would never consider assisted dying but he wanted assistance from a higher power. He had been praying for his lord to take him.

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Palace of Care – Being Wrong

Photo by 愚木混株 cdd20 on Unsplash

As doctors, we are trained to make our best attempt at diagnosis and prognostication. We gather as much evidence as we can to support our theories or disprove them. We try our best to get as clear an answer as possible. We pride ourselves on getting things right. We may check things a number of times just to make extra sure as we don’t want to get things wrong if we can help it.

Working in palliative care I don’t mind getting things wrong and sometimes I wish I was wrong more often when it comes to prognostication. The clinical examination findings are considered along with recent blood results. A picture is put together and discussed with the rest of the team. I thought I knew what was going on. The patient and her husband held on to whatever hope they could. Some blood results had improved, and others had worsened. They wanted more investigations and treatments. I thought they had run out of things to have done. They hoped I was wrong. I hoped that I was wrong.

Unfortunately, I was right – The latest scan result came back and showed widespread progression of the disease.

Damn It!

Palace of Care – Preparations

Photo by Pars Sahin on Unsplash

She said she had prepared herself for death several times over the past few years. She still wanted to try to live for as long as possible but if it was not to be she could accept it. She would try to sleep, try to eat, try to enjoy what she could of this life. Her brain knew what to say. Her emotional heart at times was speechless. She didn’t want to give in to the despair, but at times she wasn’t so strong. At times she wasn’t so sure she could accept things. There was so much she could not do. So many unfulfilled dreams. Too many disappointments.

Recently she felt exhausted, not because of the usual missed meals and poor sleeping attempts, it was much deeper than that. No matter how much sleep she had, she woke up exhausted.

Despite all of the above, she was more worried about her husband and how he would cope.