Tell Me the Truth_Conversations With My Patients About Life and Death by Dr Ranjana Srivastava

Author:Dr Ranjana Srivastava [Srivastava, Ranjana]
Language: eng
Format: epub
ISBN: 9781925750966
Amazon: B006O8VGQY
Publisher: Penguin eBooks
Published: 2010-08-25T00:00:00+00:00

Letting go

It is not death that a man should fear but he should fear never beginning to live.

Marcus Aurelius

THE PATIENT’S SCREAMS reverberated around the intensive care unit until it was hard to fathom how such suffering could exist within the walls of a sophisticated hospital. It was impossible to focus amid the commotion and the many pained expressions that greeted it.

I found out from a nurse that a frail, bed-bound woman with dementia had developed a gangrenous foot. Her family had initially decided against an amputation, as recovery would be impossible, but when her consciousness began to falter due to sepsis, so did their determination to avoid an operation.

The family now decided that the patient should undergo surgery despite the risk. This is a common enough situation and it’s possible that sitting down with the family and absolving them of the responsibility they felt for her impending death would have allowed the patient to die peacefully. This required an explanation that there was more at stake than surviving the surgery itself, there also needed to be some measurable benefit to a cognitively impaired patient. But these negotiations take time and, faced with a deteriorating patient and an insistent family, the decision was made to amputate the septic foot and hope for the best.

The patient survived the surgery but never recovered the little function she’d had. A month later, she remained confused, visibly distressed and unable to communicate. Her background dementia worsened as a result. The intensive care unit was pierced by her cries until she was sent to the ward, where she spent another few months because the family could no longer manage her care. When she finally went home, it was with costly community supports, round-the-clock family attendance, and no insight into her situation.

For all those who met her, this poor woman was a stark representation of the lingering death we all fear, and her case prompted much soul-searching. She symbolised the worst of what happens when we are incapacitated, have not made our wishes clear beforehand, and our loved ones are hard-pressed to decide what is in our best interest.

Watching her prolonged suffering, I couldn’t help thinking back to patients and families who had succeeded in letting go when it mustn’t have been easy. The most memorable of such patients was Ali.

At just twenty-two, Ali packed in the poise and wisdom of someone thrice his age. He had arrived in hospital with abdominal pain thought to be appendicitis but emerged from surgery with a diagnosis of advanced cancer. Everyone was devastated. The surgeon, with children of her own, was clearly shaken when she told him and his parents that she could not offer a cure.

I had dreaded my first meeting with them because I rarely looked after patients as young as Ali. I didn’t know what I could say to console them but I wanted to be truthful. I said that I, along with everyone, was saddened and puzzled by Ali’s diagnosis. His illness was incurable, but I would dedicate myself to helping him live as long as possible.

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