Yesterday I was out with one of the community palliative care nurses from the hospice I’m spending this year’s Medsoc. I’ve been out with community nurses before – just a few visits to little old ladies to change the bandages on their leg ulcers, nothing major (or fragrant). It’s a nice change from sitting in lectures, and it’s hands on. The palliative nurses, much like the doctors, are so unbelievably nice and they really do know their patients – it felt like visiting friends, a bit.
You’d think, then, that I would have had a good day. No. The nurse was a lovely lady, but the nicest and most cheerful person in the world could not have made up for what I saw and heard.
We started on a little old lady with very advanced Alzheimers and colon cancer. She was sound asleep when we arrived. Her daughters chatted to us and asked a lot of questions, but there was that heaviness in the air of total sadness. They explained how she kept “plucking” in the air until recently when she became so weak she couldn’t lift her arms. She was probably hallucinating. Her husband came home and looked as though he was going to burst into tears any second. The nurse reassured them about their actions over the last few days and checked her drugs chart – a bit of Haloperidol and Midazolam with the pain killers. We couldn’t do anything else so made our way out.
I was a little drained from that first visit, and it didn’t set me up well for the next encounter.
An oriental family gathered around their husband/father’s bed as he lay there, still, with an NG tube, stoma bag and catheter trailing away from him. The family looked fine at first, but then the subtleties became obvious; the old dirty tee-shirts, the unclean hair, the tired bags under their eyes – a family under stress. The fact they greeted me at all was surprising, but their assumed cheer and friendliness was quite startling. I took care not to stand at the end of the bed, being tall and dressed in black (not something I would want to wake up and see, certainly).
Things seemed as well as one could hope for at first. The patient greeted me weakly but heartily and his family asked me a few questions. The nurse went off to another room and his wife and daughter stayed round his bed. Two community nurses came and left. I had sat down to speak quietly to an aunty when wailing pierced the sombre atmosphere. Everyone swept to the bed and I saw it was his wife who was making the noise. She was crying, the daughter too, and speaking in another language. She switched to English, probably so the nurse would come back. He had stopped breathing and squeezing her hand.
“Please pappy, wait for Charlotte!”, the daughter kept screaming. It turns out Charlotte was an absent daughter. My nurse flew onto the scene and quickly reassured the family that he was still alive but had clearly gone downhill (in 5 minutes!). I looked closer and saw his laboured, weak breathing. The family were convinced he was dead, or was going to be so in a short while, and the grief mounted as more relatives arrived. No reassurance could help, but we stayed with them for a few hours. Eventually we had to go to another patient and so we reluctantly left them in utter despair.
I sat in the car quite shell-shocked. The nurse asked if I was OK and I put on a brave face. We had lunch and went to the next patient.
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