Not Cap’n Crunch cereal but he ate them like lollies, 5 tablets at a time crunched in his mouth like candies. It was strangely fascinating to watch him do it.
Were they really helping him? We didn’t really know, but that’s what his Cardiologist had recommended at their last appointment, and as a model patient he would follow the instructions carefully.
It hadn’t always been like this, two years before life in his small town was normal. Not much to do in the weekends, so like everybody else his age he dabbled in recreational drugs.
Weeks later and his breathing became worse, he thought it was due to a reactivation of his childhood asthma. He didn’t do anything about it but then things worsened and he went to see his doctor. He was prescribed Asthma inhalers but they were ineffective. Back and forth to the doctor he went, with no improvement. A chest x-ray was ordered and surprisingly showed severe heart failure. Further investigations were performed including an echocardiogram. Working diagnosis was of severe cardiomyopathy secondary to methamphetamine abuse. The drugs he used had left his heart permanently damaged.
I have only ever played the computerised version of Dungeons and Dragons, the fantasy role-playing game, and the version I played was more of a battle simulator. You went on quests with your band of characters, exploring different places, constantly running into trouble. Fights would involve cold hard steel, and mysterious magical spells. Some spells had obvious intended effects, e.g. Stinking Cloud (now that’s magic that I have understood since I discovered baked beans as a kid,) Hold person. A favourite spell of mine was Charm Person, casting this spell on an enemy could instantly change them into a team-mate.
As I started practising medicine as a junior doctor I often fancifully wished that some of the Dungeons and Dragons spells would work in real life. Over the past 22 years I have searched for Heal Person, Cure wounds, Revivify and have been caught short. If only life was that easy. I often wish that I had a magic wand that could change my patients condition for the better, I really do. Or magic pills or potions that would lead to a cure. Sometimes the best magic I can offer is to soothe suffering, provide comfort, offer support. On occasions I have had to use Charm Person, and sometimes even Charm Monster.
Illness can bring out the worst in people, but some people might not have been all that easy to get along with even when they were physically well. There are no difficult people or patients but at times communicating with humans can prove to be a difficult endeavour.
I was asked by medical students, what was my favourite part of working in Palliative Care? I instantly replied, having a laugh with my patients and their families. Even though a person may be dying, they hold on strong to their sense of humour as it still feels good to laugh. To see the lighter side of even your own end of life is something that I have seen often. People still want to feel included in life and still want to have some fun. To be treated like a normal human being. My favourite thing after 22 years of medical practice is having a good laugh with my patients.
Last Friday, we had a great time joking around, whilst getting to know each other better. Pain and nausea had settled after a few days of hospice work. It was good to meet him properly for the first time, with his quick wit in full flight. I had trouble keeping up with him, a quip every other minute, followed by puns. Two proponents of Dad Jokes performing sit-down comedy, both riffing off each other’s comments, and enormously enjoying each other’s company. Each the perfect audience for the other. Our companions in the room were briefly forgotten, but we didn’t want them to feel lonely and started including them in our fun making. My team mates were included and then my comedy partner’s family. There were no taboo subjects as we launched into our roast of our room-mates.
His blood test results came back and were unusually good, the blast cells were reduced in numbers compared to on admission. Bloods were repeated weekly, and they continued to improve, to the point that there were no longer blast cells present at all. The Haematologist was contacted about this unexpected finding. She was surprised as his blood tests hinted at something that they had never been able to achieve before. Was this a remission?
A bone marrow biopsy was urgently organised, and revealed a pre-Christmas miracle – remission was confirmed. Somehow his disease had been controlled, by what we all did not know. Plans were hastily made for our patient to undergo a bone marrow transplant, with everyone’s hopes raised that it would lead to longer term control.
Our patient had mixed emotions, since he had become sick this was the first time that he had received good news, and he didn’t know how to handle it. He didn’t celebrate his remission as much as his family and clinicians did, as he couldn’t totally believe it. He was discharged home to his family’s rented home for Christmas together, with everyone hoping that a better year lay ahead.
What the heck was going on in the lounge? A patient’s family and the doctors were sitting on the floor with their legs crossed. Were they about to break out into song? Kumbaya my lord, Kumbaya…? Was this part of the Hospice Yoga Initiative? Mat-time at a new New Zealand charter school? No, it was actually a family meeting.
Family meetings are common occurrences in healthcare settings and are organized in order to convey a point of view, or to try to bring together disparate points of views. These events may actually be the first chance that some of the key stakeholders, i.e. the family and the healthcare team, actually have to meet each other. The first time that the next of kin has made time to meet with the health care team looking after their loved one. First impressions as within any first meeting are important. As you can only meet for the first time once, you’d better do your best to make sure it goes well. In order to establish a trusting therapeutic relationship between the patient, their family and the health-care team, rapport must be established quickly. Every encounter can count, but not everything can be planned for. Continue reading →