Friday, July 9, 2010


Tuesday was the only day I went in to my main place this week. I spent a lot of time sitting with a couple of patients. These two have conditions - permanent and genetic, that require treatment similar to that undergone by cancer patients, though they are not cancer. Thus these two end up on our floor. One is young and has dealt with her problem on and off throughout her life (PT A). Currently, she's experiencing a particularly long "crisis" proving stubborn to treatment. Otherwise, she's in fairly good shape. Among her problems is pain in her joints just one of the many possible complications from her condition. She's very personable and chatty, clearly animated and intelligent, and thus lonely and bored. She's part of a large family who visit frequently, but even with that, in a hospital one always ends up spending large chunks of time lacking in company. She asked for drawing and coloring materials, which I got from one of the social workers. We didn't get around to actually producing any art, instead we talked about stuff, family, life. What she did, where she lived, her family. My family, where we've lived. She was somewhat in pain, but totally ambulatory - in so far as one can be with an IV. Despite her discomfort and uncertainty as to how long this crisis would last, she was in very good spirits.

Now I know more about her condition, and the long-term prognosis, primarily a severely shortened life-span, her cheerful disposition is a lesson indeed. As is her determination to complete her Bachelors, progress on which has been curtailed by dealing with her condition. She talked about where she'd wanted to study, the same place her mother studied. This didn't work out, but she did start at a good, local institution and made progress toward her degree. She really wants to get back to it and complete it.

Her fellow-floormate is an older lady who, while burdened with a similarly unfortunate and genetically predetermined burden it is one that did not afflict her until much later in life (PT G). She's only experienced it for a year or so, but it's made rapid progress. She's in the position of having to come to terms with possibly having to rethink her entire life-style. Until fairly recently she was able to go about her daily life - a leisurely retired existence, while making some accommodations to this newly present discomfort in her body. However, her current predicament suggests that this may no longer be the case. She has already handed her beloved cat over to her best friend; this is very sad, since he was great company for her. She was no longer able to take care of him, since she can't open cans or shop like she used to. Her arms and hands are somewhat weak - I open packages for her on her meal tray, and while she was able to feed herself and cut up her own food, her dining was slow. She was talking at length at the same time, to be fair, and if I'd not been there for her to talk to, she'd have been somewhat quicker, though I doubt much. I think her weakness is largely due to not having eaten properly for a while and not being able to sleep. Her condition means she's at severe danger from bruising and bleeding from the slightest knock, and even spontaneously in fact. With this in your life it means you've got to be really careful about everything you do. Anything could cause a horrendous health problem. The poor lady had also just had eye surgery that will take several weeks to resolve itself. Then she'll see better; in the meantime though, it means she can't see out of one eye. This was also impacting on her eating speed since the bad eye was on the same side as her tray table where her lunch was. She didn't want me to move the table since that'd be on the wrong side for her right hand.

She had been in pain in her back and down both legs. She'd been trying to deal with it at home, but her OTC options are limited due to anything aspirin-related being off the list. This had been going on for a couple of days or so, during which she'd had a minor fall on one knee. She'd gone to her local ER and was sent home with pain-killers, well, a prescription for some at any rate, but one which she couldn't fill due to her pain and condition. Meanwhile, her injured knee had produced an alarming amount of bruising down the bottom half of that leg, with a "slipper" of bruising along the bottom of her foot, just above the sole. This looked rather alarming to me when I first encountered her, but then she explained why she was there and that it really had nothing to do with this dramatic bruising.

She told me what she'd been doing in her life. She'd worked in finance, and continued to work full-time to the last possible moment she could until retirement. Thus she ensured receipt of the best pension possible. She'd been retired for around a couple of years and had been enjoying pottering around her house with her cat, watching TV, and generally taking it easy. She'd had no grand travel plans and such, as many do when thinking of retirement, which, as she said, has proved fortunate given her current health situation. She'd been part of a drug therapy study from which she was removed when the drugs no longer worked - they'd provided a brief improvement, but this was not to last. She had then been undergoing periodic transfusions, which became more frequent, and were now weekly. And now she was experiencing this current crisis, which was indicating that her condition had exacerbated.

Sickle-cell and MDS: long-term prognosis for either of these is not great.

Another patient I'd been spending some time with, who'd been there for quite a while was not on the floor (PT AH). This lady had been visibly deteriorating and had been recently almost constantly asleep. I asked where she was and was told that she'd passed away Saturday night. This was expected, unlike the fellow who'd died the previous Monday morning. He'd seemed in fairly good shape, given the circumstances.

Around five patients that I've had some contact with, some brief, some lengthy interactions, conversations, have died since I started on this floor. It's proved a wonderful opportunity, prompt perhaps, to ponder various of life's questions but also chiefly one's role in the room with the patient. Constantly one remembers that it's nothing personal for you, that who you are is irrelevant, it's about being available for them. This can mean just being there, as a comforting presence, providing a foil for light, distracting conversation, or a sounding board for life-style readjustment, amongst many other things.

1 comment:

  1. The following week I heard that PT L had returned to the floor from home and had died the previous Monday morning, very early. She was not comfortable at all, but had come to terms with her impending death. She had many people around her when the time came.