when i was a child we used to hear stories of old people from primitive cultures that could wish themselves dead. they could just decide to die and they would. it was disturbingly fascinating for a young impressionable boy. but as i grew older and studied medicine i realised they were no more than simple stories. or were they?
i was a lowly medical officer joining the boss' firm for the first time. i luckily learned the registrar was a great guy and i therefore could use him as a sort of shield against the usual onslaught of the boss. when i joined there was a patient who had undergone a gastrectomy the previous day for a benign condition. it fell to me and my registrar to get her back to full health. it soon dawned on me this would not be easy.
the patient was 60 something and well fed, possibly too well fed. mobilization was difficult, but that wasn't the main problem. she was of a culture where a certain amount of self pity was the norm and where showing suffering elicited great sympathy from family members. so when we insisted she start moving soon after the operation, she was not interested. what's more, her family encouraged her to just lie in bed like a lump of clay. they felt we were downright cruel to expect such things as getting out of bed of her. but i became truly worried one day when she called my registrar and myself over to tell us something in confidence.
"i want to die. help me kill myself." she said with a pan face. we were shocked. we explained that she actually had a lot of life left in her and her condition was not terminal. with a bit of effort we expected a full recovery. but a full recovery was one thing she was not willing to give us. and eternal rest was one thing we were not willing to give her. every day we would get her out of bed and walk with her and every day she would walk a few steps with a fair amount of ease and then collapse in a heap on the floor. we would then wrestle her back into bed and muster our energy for the next day's ritual. the family complained incessantly about everything we did. they wanted her to stay in bed and wait until one day when she would just be better.
after a while her son flew in from america where he lived. he came armed with dollars and instantly decided our care was not good enough. almost immediately they had moved her to a private step down facility where she was to be pampered back to health. truth be told, we were relieved. it wasn't as if we didn't have other things to do to keep our days busy and we were quite willing to give up our daily walks and wrestling matches with this patient.
about two weeks later we got a call from a local private hospital. they told us that at the step down facility the lady had adopted a very passive stance on the matter of her recovery and not moved a muscle. she had then one day apparently stopped breathing. she was intubated and shuffled off to the local private hospital where she was bundled into an icu bed where even american dollars wouldn't last too long. when the son with the american dollars realised he had no more american dollars, they phoned us at the state hospital to take over. what could we do? i turned to my registrar.
"you realise she will absolutely refuse to recover. she will be an albatross around your neck until she dies and she is going to die. she wills it so." he tried to smile but it came out as a sort of accepting expression of suffering. we took her back but her condition had worsened. other than the endotracheal tube and the ventilator, she returned with a nice hefty bedsore on her sacrum. but we were not the types to give up too easily and we immediately got to work.
everyone was surprised when we actually managed to get her off the ventilator in less than a week. a few days later we had her back in the ward and a few days after this we even commenced our daily excursions with her. during this time once again she asked us to kill her. she assured us she wouldn't tell anyone if we did. somehow that seemed self explanatory to me but i decided not to point it out. anyway we refused, once again saying that she was not terminal and with a bit of hard work should recover completely. she wasn't happy with us telling her what to do, even if what we were saying was that she should recover. apparently, she assured us, her family were much more sympathetic. they didn't force her out of bed daily for example. we tried to look more understanding from then on when we forced her out of bed. i think it worked to an extent because just before i was rotated out of the firm and to the other hospital, we actually discharged her back to her understanding family. i was delighted, but my senior was less so. you see, he was staying on in that firm and he knew she was going to do what albatrosses do. she was going to bounce right back to him. i pretended to care but it was his albatross and not mine. i was just too delighted to finally get away from a situation that i knew would turn out badly.
and so life went on as it tends to do. i settled into my new firm and soon even forgot about the albatross. i couldn't for long though. quite soon my previous registrar phoned me. he said only one thing but the pain in his voice said so much more.
"the albatross is back." i expressed dismay and even tried to sound surprised, but it just came out as insincere, which is exactly what it was. i considered asking a bit about her condition but somehow it seemed it would rub salt into his wounds. i even considered making a light hearted joke about him granting her her wish and helping her over the threshold into the hereafter. i was just afraid he might take me seriously, so i said nothing.
not too long after that phone call i got a message on my phone.
"the albatross has flown". she was dead. she had finally managed to bypass all our attempts to get her back on her feet and despite everything we had done, against overwhelming odds, she had wished herself into the grave. in a way i was even quite impressed with her.
since then i too have had an albatross or two. i suppose it goes with the job.
Monday, June 14, 2010
Labels: death, gastrectomy, icu, terminal care
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Aai jong! That is truly very sad that anyone would want to end their life...maybe a psych consult wouldn't have been a bad idea.
Interesting and frustrating I bet. I had not heard the albatross analogy before.
I've also never heard of the albatross analogy, but now that I know, I don't think I'll forget it in a hurry!
I guess the 'mind over body' thing works both ways hey?
Would she not have been referred for some sort of psychological consultation? It sounds like her problems were more psychological - not that I am a medical professional or anything.....
it reminds me of that fella in that wonderful Moby Dick film. you know the one that just decided one day to die and had a coffin built for himself.
anyhow now we are trying SO hard to save money here in the nhs. we have to "fast track" our patients. in other words they are supposed to get them out of bed 6 hours post things like anterior resections and hemicolectomies. oh and also they all got to have a high protein drink 2 hours post op. (e.g. a milk shake). i pointed out that the patients will be sick and will also faint. However the intensivist thinks i am old fashioned and has now writen a policy about giving 3mg i.v. ephidrine prior to getting patients out of bed. Shuz man its like we are loading the poor old buggers up with amphetamines. i am sure they will all develop AF. also apparently no one needs bowel prep anymore. so the poor surgeons must have loops of poo to handle.
zamalek and lynda, we did get a psychologist to see her and she was also on antidepressants, but the problem also had a cultural root and there is little one can do against culture.
cal and jayne the albatross analogy comes from samuel taylor coleridge's poem The rime of the ancient mariner where an albatross was tied around his neck as punishment. it means a burden you just can't get rid of.
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