Sunday, September 7, 2008

Going home

Last week, we sent a man home to die.

Cancer had ravaged his body. His abdomen was swollen with fluid, taut and tense and shiny. Each day he became a little more breathless. Each day he would eat less... finally able only to take water, squeezed into his mouth from a soaked piece of cotton wool. Each day we would infuse albumin, plasma and blood, trying desperately to replace the proteins being leached out of his system. Each day a large needle would be inserted through the abdominal wall as we tried to drain out the malignant collection of fluid. 4 liters on the first day, 2 1/2 on the second.... after about a week, less than 1 liter coming out as the fluid started clotting in the tubing system.

He was a farmer, from a rural area far away from Colombo. His relatives traveled long distances to see him. Father to 5 children, many expenses were met by the employer of his eldest child. They were a devoted family... someone was at his side 24/7, medical instructions were meticulously followed, some sign of recovery anxiously awaited.

Tissue taken from the ugly mass in his abdomen was examined by pathologists. High grade sarcoma... a particularly aggressive liver tumour. Surgery was not possible. Chemotherapy and radiotherapy have not been shown to work much. The plan was to refer to an oncologist, and then transfer to the Cancer Institute, Maharagama. That would take a few days... the patient was deteriorating day by day, slowly dying.

We spoke to the relatives, to his wife and her sister, to the sons and daughters. Gently we told them not to expect too much. How can you ask a fellow human being not to hope? Yet we cannot falsely reassure...

They came to us one day, tears brimming in their eyes. Could we transfer him to M..........., a base hospital close to their home? They were prepared to arrange a vehicle... a van would cost them 5 thousand rupees... a hearse would cost 50 grand. Is it not pathetic? Can you imagine what was going through their minds as they made that request? I stifled my own tears while my colleague assured them that we would try our best.

Permission was granted by those at the top - yes, transfer to local hospital on humanitarian grounds. We may not be able to relieve their emotional distress, but maybe we could ease their financial burden. The patient was in no condition to travel in an ordinary van. The rules are such that to transfer a patient from NHSL for such a purpose, we need to wait for an ambulance from the relevant hospital to come to Colombo. An ambulance from M.......... would take days, if not weeks to come. This patient didn't have that long.

Private ambulance services were called up... the tab was Rs. 10,000/-. The family was seen outside the ward, pooling and counting the money from their purses. Orange notes and blue ones. Not many green notes to be seen. Dr. E then had his brainwave... could we not ask the Director to authorize an ambulance for this patient? The letter was carefully composed, highlighting the desperate situation. The authorization came in less than an hour and before evening, the patient was on his way home. His young son called later that night to say they had reached the local hospital safely.

The second call came the following morning. Our patient had stopped breathing... the end had come. That 18 year old boy who had watched his father die could not stop his sobs as he spoke over the phone. He understood that we are all destined to live a certain span of years and that when the ayusha (life force) runs out, we all have to leave. His last words before he returned to the sad duties of last rites and burials were "Doctor, waattuwe hamotama godak pin. Budu saranai".

16 comments:

T said...

wow angel, that really made me cry, (and i dont cry easy). its so awful and sad.

uhu said...

I wiped a few tears of my own while reading... its a painful story... and also.. I guess its because the person who most loved me, died in June. I keep reliving that moment, and kicking myself for not doing it right. When she said "I am afraid" I tried to make light of it. I guess I just wanted to give her confidence... but tears flow now when I think of it.

Finally, after meditating on the 23rd Psalm, she decided to call it a day.

surani said...

Oh noooo...I was crying by the time I finished reading this post (and I was in office!)
Life is so hard sometimes...

Anonymous said...

Dear Angel, You and your colleagues are doing an immense service to our nation. Each time, something unpleasant happens, remember that you have done immense good and you have helped so many people in the process.

Scrumpulicious said...

Silent tears as I read this! I can't even begin to imagine what the family must have been going through. My prayers are with them.

santhoshi said...

Very sad and painful story. Thanks for sharing it with us, it makes all other petty problems in life really that petty.

stfallen said...

hmmm...
that is sad...
my aunt died of cancer
I have no idea as to what type
it was the first death I had to deal with
I broke into tears when I heard the news
but that was the last time I cried in a long time...
the only time after that was an emotional breakdown I guess you could call it...

I hope the family gets through it
strange I'm listening to Fiona Apple's Tidal album and this line struck me cause I'm on your blog :P
"So what would an angel say the devil wants to know"
hahaha

hmm..
have you listened to my demo btw? (:

Jack Point said...

A very moving post.

Jack Point said...

There is a nobility in that simple deed that goes right to the core of what medicine is all about. I dont remember who said it but ' to cure: sometimes, to relive: often; to comfort, always'.

Perhaps there is hope after all for this benighted land.

DeeCee said...

Poverty is unbearable when you are forced to watch it take place. You are blessed to be able to help these people...

~ lo$t $oul ~ said...

painful isnt it?!?! to be even telling them abt the death or even hearing about it..

Angel said...

T, Surani, Scrump, Santhoshi : I cried a lot too. Some stories just don't have a happy ending.

Uhu : I'm sorry about your loss (hug), I'm glad she found solace... I've always liked the 23rd psalm.

Annon : thanks

St Fallen : I'm sorry about your aunt (hug). Death is very hard to deal with, no matter when or where it turns up. Lol about the song... and where can I hear your demo? On your blog?

Jack point : thanks... my role is a very small one tho. And i believe it was Hippocrates who said that...

Deecee : thanks, that was the only aspect I felt even vaguely good about... that we had actually done something positive

Lo$t : I know... sadly, it wasn't the first and won't be the last... i.e., stay tuned for more morbid posts... :(

sach said...

oh man. i don't really have much to say because after reading that, anything I say would sound hollow and meaningless.

Sachintha said...

I had to fight my tears a lot, because I'm right here in my office...

But it's a story worth crying... and I don't usually cry...

It's just the way of life I guess...

Pradeep Jeganathan said...

same here. wow

Angel said...

Sachintha, Pradeep : Thanks...