Tag Archives: last wishes

Palace of Care – Looking Ahead

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Photo by Arthur Ogleznev on Unsplash

Everything can change so quickly, often with no warning. We can’t prepare the family when we are unprepared ourselves.

He had come in to sort out his pain. Bowel motions were excruciating for him. He had needed laxatives to keep him regular. He had decided to stop his laxatives. No more bowel motions meant less pain he figured. Less pain, less need for pain relief, less side effects. It made good sense to him, and initially, it had worked. It couldn’t last though, what needed to be expelled could not be kept in. When it did come out it had dried out and caused even worse pain. He finally accepted our offer of admission.

The assessing doctor found out the patient had haemorrhoids – painful swollen blood vessels which would be worsened if he had hard dry poos. The fix was to soften them up and make them easier and more comfortable to pass. It took five days to achieve this and heading back home after the weekend looked like a distinct possibility.

After the weekend he looked good. He had taken some successful leave periods at home when the family were off work and school. The next day he was different. He was slow to answer and his replies were in a confused manner. He complained that he couldn’t pass urine. He had repeated bladder scans which didn’t find a full bladder. His pain was worse, he also felt nauseated. He appeared to be in a bad mood and was not as friendly as usual. He was more withdrawn and needed to sleep more. Blood tests were taken in an attempt to find out what was going on.

Severe kidney failure was what the results showed, a life-threatening deterioration, that would likely lead to his death. He was clear he did not want to go back to the hospital. He didn’t want to stay in hospice. He wanted to go home. He couldn’t wait until the doctors came to see him, he had to go home as soon as possible. He’d spent too much time away from home in the last few months.

The doctors went into his room and our patient had gone “AWOL!” He couldn’t wait for the ward round he needed to go home as soon as possible. The team arranged for some urgent prescriptions as we didn’t want him to end up in strife. Good teamwork made it happen.

We received word from his family later in the afternoon that he had died. How had he known?

Palace of Care – Country Roads

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Photo by Devon MacKay on Unsplash

The odds were against him but he wanted to at least try. Even if he died on the way home it would be worth it. As long as he was heading in the direction of his heart. Back to the ancestral home where generations of his family had lived. No matter how far away from there they had gone they still thought of it as home. Even those who had moved overseas many years ago still maintained the connection.

It was the hardest thing he had ever done, but it was the most important thing for him. He left the place he had lived in for most of his adult life to go on his final journey. It would be a long ride in the car. Bumps in the road hurt him the most, and there were many patches of roughness along the way. He held on, he wanted to make it. His family were expecting him and had made preparations. They had organised a bed in one of the rooms. He hadn’t been back for years, life had been too busy.

He felt so tired, he wasn’t sure if there was enough time left. The doctors had told him days ago that there were only days left. He was so tired. He would only let himself rest for a short time. He had to be awake to will himself to his destination. He tried to keep his eyes open, but his eyelids felt too heavy, he just couldn’t keep them up.

He woke with a start. A large truck had been going in the opposite direction and the vibrations from its wake had shaken their small car. They were on a country road, there were no lights around them, and the road was deserted. They drove alongside a stream, that’s where they used to go eeling when they were kids. Around the corner, they turned and he saw a dim light in the distance. They headed up the gravel driveway, and he saw her in the doorway.

The light from the house reflected in the two wet tracks down her cheeks, “Welcome home son.”

Palace of Care – Home Please

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Photo by Mike Coker on Unsplash

He wanted to go home. It wasn’t going to be easy, but that’s what he wanted most of all. To go back to where it had all begun. Back to his ancestral home. He was at risk of dying on the way but it was important that he at least try. It wouldn’t be easy for his family. There was much less formal support available in the small town he was born in. He would have to rely on his family members to look after him.

The practicalities needed to be sorted out. Who could provide equipment and home support? These things can be hard enough to arrange urgently in metropolitan areas let alone in rural New Zealand. The postcode lottery of our health system continues to provide a stark reality check. Healthcare provision levels depend on where you live. If you live in the city, you will likely be well-supported. Outside of our big cities, the local support networks are much more limited. The country mouse and the city mouse have very different quality of living, and also quality of dying.

An exceptional case called for a lot of networking to make the trip home as smooth as possible. What medications would be needed? Where would he get his medications from? What was going to happen overnight? What would happen when he died? Who would fill out the required certificates? We didn’t have all the answers and we needed to make our plans up as we went along.

Would he make it?