Death and the Migrant by Gunaratnam Yasmin;

Author:Gunaratnam, Yasmin;
Language: eng
Format: epub
ISBN: 1538983
Publisher: Bloomsbury Publishing Plc
Published: 2013-12-14T16:00:00+00:00

10

Failing, Falling

About ten or so years ago, Denise Brady, the librarian at St Christopher’s Hospice, showed me an extraordinary article. The paper, by Margaret Clarke, Illora Finlay and Ian Campbell, published in 1991 in the journal Palliative Medicine, is a compelling, short account of the end-of-life care of a recent migrant to Wales. The article opens with a salutary warning, insinuating discomfort in the palliative care reader from the offset ‘It is easy to develop a complacent smugness about our caring’ the authors write; the implication being that the acute vulnerability of dying can render patients and their loved ones overly grateful and uncritical.1 For these wounded healers, it is the failures of care that are the most instructive.

The story, told in just three pages, is about a Korean family that spoke some English and where the mother, who was the patient, spoke none at all. She had undergone a mastectomy in Korea four years previously, but there was no paperwork from her doctors so it had not been possible to establish what the mastectomy had been for. The woman had had one dose of chemotherapy in the United Kingdom, which was presumed to be for a recurrence of breast cancer. She appeared to have refused further treatment or follow-up care.

When the hospice consultant visited the family, on the request of the patient’s General Practitioner, the woman ‘was lying flat on a board on the base of a single bed. She looked frightened and had obvious pain on movement’. Her husband did not believe in Western medicine and had been administering faith healing. This had included the whole family fasting over the preceding three months. They ate fresh fruit, no animal products or vegetable carbohydrates. The three children aged five, 11 and 13 had been allowed bread and boiled vegetables. The husband consented to a hospice admission on the condition that the fast continued and that his wife would not be given any drugs.

An image of the woman’s chest X-ray on admission to the hospice is included in the article. It is described as showing ‘multiple cavitating lesions with apical scarring consistent with advanced pulmonary tuberculosis’.2 Analysis of the mother’s sputum was negative for acid-fast bacilli and for malignant cells. ‘Her country of origin, the lack of documented histology of the mastectomy and her clinical state suggested a possible diagnosis of TB’, the authors tell us. During the early days of her hospice stay, the husband had continued to refuse analgesia on his wife’s behalf. He subsequently agreed to one mg diamorphine intravenously every four to six hours and to liquid vegetarian dietary supplements. Communication with the family was impeded by language differences, further compounded by tensions with local interpreters whose help they had rejected on previous occasions.

The woman was given antituberculous therapy and improved during the first four days of treatment. She collapsed suddenly on the sixth day ‘becoming rapidly shocked, clinically comparable with a Herxheimer reaction’ (where a body eliminates toxins at a fast rate). In the last hours of her life the family sang hymns.

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