today, in hospital... 9/06/2010

a palliative care week lay ahead...

all of us were assigned to our own patients.

so it was, I was assigned to my patient...

the hospital day started.

I must say, the doctors and nurses in palliative care certainly carry a different flavour with them. Amidst a drone of sadness in the background, I see amongst the healthcare team - smiles, much more than in the busier hospitals, accompanied by a certain warmth, dedication and perhaps even, compassion.

it was 9.15a.m. in the morning, and we met our princple tutor, a registrar who brought us around the hospital.

there were five of us in all. six if you included the doctor.

today, as educational as it was, it was educational to the heart of medicine.

I saw a doctor transform into a cute'sy character just to bring some smiles onto the hospital beds - a certain compassion I'm inspired by, one which I should work to gain... and also one which I should never lose.

of all days, this is a day in hospital where I felt like I really wanted to be a doctor... well, I always thought I wanted to be a doctor, today i felt it inside... and certainly, palliative care wasn't just all about pain relief, symptom control, treatments, home visits, counsellors... ... Its about the heart of being a doctor.

there was an anomaly to the norm... a stark contrast... a temporary medical resident was on her temporary rotation in palliative care...

"Can you see this patient and find out how he's doing?" our doctor asked the resident, and in a quick little hurry, he ran off to settle something else...

so it was the five of us, and her... she was strange... scary in fact...

to break the silence, in a happy cheery voice, she told us.... "I want to have as little contact with patients as possible. That's why I'm going to be a pathologist" she said smiling... and then, she starting going on about how she loved several hospitals for being near a beach and being relaxed...

Stumped and speechless... well, we didn't really know what to say either.
the doctor came back, "How's the patient doing?" ....

so quickly, with a finger pointed toward the doctor, she spoke...

"The patient wants to see you..."
i guess she... lied...

but it wasn't so much about the lie, but knowing that she was doing all these without a certain 'heart' for it... a certain 'fake'ness in her smile makes me... if i could use a word to bring it to an extreme, then that word would be 'shudder'.

Lunch break. 1.30-2.45pm... had aporto for my first time. it was pretty decent :)

It was time to meet our allocated patients. I always get a little nervous before meeting patients, but once it starts going, I lose the nervousness and it gradually dissipitates in the background...

so I do the normal - a standard introduction, a greeting, and asked for permission, sat down...

and the conversation starts...

you really wonder what to say to patients who are facing a certain eminent death. you cannot really say "i hope you get better" or "don't worry about this" or "its alright" or "i'm sure the doctor's got it in control" or... ...

10 minutes prior to the conversation, I had written some pointers and questions down, a list of them, appropriate ones to ask...

so it was, I began to chat with Mr. B, a 76 y.o. gentlemen who was in the midst of painting a really pretty picture of flowers. He was quite good actually, carefully adding layer to layer of paint, waiting for each layer to dry before adding the next... what he calls every subsequent piece of art, an improvement from a previous painting.

Mr. B was a person of interesting character. Clearly, with a clear, sharp and analytical mind, and a hint of obsession with logic and reason, he analysed the people around him, the things people do - the drugs he takes, the nurses, the doctors, his paintings....

"In my whole life, I have never seen! no *shakes head* never... never seen such a group of people (the nurses) so dedicated to their work. If it were me, I meant if it were me, I'd get pissed off in 20 minutes, put my head in a gas chamber and get outta here. There are people pissing in their pants, people complaining all the time, and but, there's a certain something about these people. I've worked in so many places... well, I am an electrical engineer, and 'astro-physicist'... I deal with machines, parts, engineering... ... and met so many people, but never in my life seen such a dedicated team of people. Well, let me tell you about one of the nurses..."

at this time, his eyes were drawn into space, as though in deep thought. But not being able to grasp the right word to say, he finally surrenders to a relatively normal word, if it was normal at all

"She's special..."

"There's something special about her. You see the man opposite me, well, he was crying. And you know what she did? She hugged him. She didn't have to. She wasn't obliged to. She wasn't family. You know how families are, 'Well, dad's sick. we've gotta visit him and make sure he's okay...', they are obliged to. At first, I thought she was the daughter, but turns out she wasn't. She did not need to be all 'cuddley and kissy' with a sick old man.. yes, a sick old man. She didn't have to do all that, but she did. You don't normally go around hugging people who are old, dying, and who shit in their pants. And me, she hugged me too. She's special"

and that was something new to me too...

the conversation went on, and I asked, "What concerns you the most now?"

"Staying alive and living on. You know, how we are made up of the physical and the mental... and as time passes..."

and Mr. B. paused, and in a crackled speech said "we get weaker and weaker, till both fades away... that's how my wife went last year, and what we all have to go through..."

and teary-eyed he was... it was my first encounter with a man crying

2 weeks ago, a vietnamese mother with breast cancer, teared up too because she couldn't believe it was happening to her, and she still had to a 15 year old child to look after. It was hard, sure it was with chemotherapy. There was a sense of helplessness, a loss of control, as cancer and its treatment began to take over her life...

and in this man, somewhat similar... but different too...

I looked over, and a little lost for what to do... understanding where he was coming from, I felt empathy... a little sad too, and only a little as compared to what he must have be going through... ...

"I'm sorry... I get all teared up when I mention this..." in a crackled voice he said, with a little fumbling, ...

Lost for what to exactly say, and I gave a gentle whisper "it's okay..." , gave in to a necessary silence... and so it was, i placed one of my hands over his wrist, and with the other, a rub over his shoulder.

and in just a while, and we started talking about things again... about his paintings... about life... and about 'care'... this patient to me, surely wasn't a 'patient dying from lung cancer', but a person who wants to live on...

"I don't know much about the nursing home. I don't want to live there. Of course I prefer to be back home, but thinking now, it might not be the best of options. My daughter she lives a fair bit from me, and to get the care the doctors say I need, its too expensive to have them at home."

"If in the nursing home, I don't want to be with a bunch of old ladies playing lotto all day. I'm scared I won't be able to do the things I want to do... I want to be able to get my tools, power sockets, shouldering iron... ... nothing really much, just some of my workshop stuff over to keep me doing thing, to keep me occupied. In this hospital, painting is the bare minimum that keeps me going. Without this, in two days, I'd put my head in a gas chamber and I'm outta here...."

and so as I said before, and say it again, it came to me that - far from being a dying 'patient', this is a person who is pressed on living...

and with this, my view on of palliative care certainly has changed. it ain't so much about dying as much as it is about living... even if it meant living your last lap of life.

and with that... I placed my arm over his shoulder, gave him a kind of a 'sideway hug' and thanked him...

today i learnt more than my fair share... it surely ain't much 'medical' as I thought it would've been... much more than medicine for the body...

compassion.

it's a type of medicine for the soul.