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".