"Go tell him that we just need to put a drain into his stomach!" my senior resident barked at me, after the nurses paged him to say that the patient had refused to go down for the procedure. I hustled towards the door, toward the patient. "It's just a drain! It's not like it's a major surgery!!" he called out, exasperated that our patient was being difficult, "Use your psychiatry skills!!"
I went to go reason with him. After all, he was my patient. And he could be reasoned with. He was nice, pleasant, intelligent, and an all-around good person. Sure, he also had Stage IV gastric cancer, but that hadn't turned him into a curmudgeon by any means. Unfortunately, his cancer had metastasized, and now his belly was full of fluid, making it near impossible for him to do anything. We had planned for him to go down to IR to get a drain placed to remove this fluid, and hopefully decompress his stomach and bowels so that everything would start working again.
I was positive this was all just a giant misunderstanding.
I went to his room. Knocked. Pulled out my best Difficult Conversations face, and started to talk with him. Why didn't he want the drain? Had the nurses misunderstood? Was he worried about the procedure? Worried about pain? Would it help if I went with him?
He looked at me. If they put the tube in, would it get rid of his cancer? No. Probably not. If they put the tube in, was he still going to die of cancer? Yes, probably so. If they didn't put the tube in, how would that change any of the previous answers?
I looked at him, not quite knowing what to say. He had come to the hospital for intervention after all, right? That's the only reason why anyone comes to the hospital, I naively thought. Yet, now he was here, and he wasn't getting anything. No food, no drain, no nothing. I tried to tell him that by placing the drain, we'd be able to feed him again. Steak? he asked. No, probably just clear liquids for now, but we'd advance his diet as soon as we saw how he tolerated it! Heck, he could be eating steak in a week!
I didn't think I was lying, just stretching the positive thinking aspect of things. But he saw right through me. Hahaha, he laughed. Steak in a week. Right.
He patted my hand, which had been resting on his bedrail. "I know I'm going to die," he said to me. "Do you realize that I'm going to die?"
I nodded, but couldn't make eye contact. He continued speaking, as I continued to look down at the hangnail on my index finger. "I'm going to die soon, child. And I'm good with that. It's God's will. It's my time. I've lived a good full fifty-four years."
The truth of the matter was, putting in the drain was only going to buy him a couple of weeks of eating. At most. And he, well, he realized that this was it. And he wanted to be at home, surrounded by friends, family, and his church choir buddies. They had made him some pretty amazing smoothies and soups the past couple of weeks. He'd just water it down some more once he got home, but he'd get the nutrients down. Somehow.
I went back to the team room, and told my resident that my patient didn't want the procedure. My resident - deeply unhappy that I hadn't done what I was told - ended up going to talk to my patient himself. I'll never know what happened during their conversation, but my patient went for the procedure two hours later, and came back to his room an hour after that, drain in place. Only to find that it wouldn't drain.
Turns out the "fluid" in his body was actually quite thick. So now IR wanted him to change out the tubing. And at that point, my patient completely refused everything. Everything but hospice. He just wanted to go home and drink his soup.
He left the next day, with my well wishes. But as he left the floor, I couldn't help but be struck by the fact that he was leaving us with a non-usable drain, that he hadn't wanted, because he didn't want to meet God with a line sticking out his stomach.
We want to fix everyone who comes into the hospital. It's why we do what we do. We want to make people better. So when it comes to the point where nothing else can be done, we start coming up with things that could be done. We want to say that we tried everything, that we did everything. But sometimes, the best thing is to do nothing.
It's a hard lesson to learn, and some of us refuse to ever learn it.
I went to go reason with him. After all, he was my patient. And he could be reasoned with. He was nice, pleasant, intelligent, and an all-around good person. Sure, he also had Stage IV gastric cancer, but that hadn't turned him into a curmudgeon by any means. Unfortunately, his cancer had metastasized, and now his belly was full of fluid, making it near impossible for him to do anything. We had planned for him to go down to IR to get a drain placed to remove this fluid, and hopefully decompress his stomach and bowels so that everything would start working again.
I was positive this was all just a giant misunderstanding.
I went to his room. Knocked. Pulled out my best Difficult Conversations face, and started to talk with him. Why didn't he want the drain? Had the nurses misunderstood? Was he worried about the procedure? Worried about pain? Would it help if I went with him?
He looked at me. If they put the tube in, would it get rid of his cancer? No. Probably not. If they put the tube in, was he still going to die of cancer? Yes, probably so. If they didn't put the tube in, how would that change any of the previous answers?
I looked at him, not quite knowing what to say. He had come to the hospital for intervention after all, right? That's the only reason why anyone comes to the hospital, I naively thought. Yet, now he was here, and he wasn't getting anything. No food, no drain, no nothing. I tried to tell him that by placing the drain, we'd be able to feed him again. Steak? he asked. No, probably just clear liquids for now, but we'd advance his diet as soon as we saw how he tolerated it! Heck, he could be eating steak in a week!
I didn't think I was lying, just stretching the positive thinking aspect of things. But he saw right through me. Hahaha, he laughed. Steak in a week. Right.
He patted my hand, which had been resting on his bedrail. "I know I'm going to die," he said to me. "Do you realize that I'm going to die?"
I nodded, but couldn't make eye contact. He continued speaking, as I continued to look down at the hangnail on my index finger. "I'm going to die soon, child. And I'm good with that. It's God's will. It's my time. I've lived a good full fifty-four years."
The truth of the matter was, putting in the drain was only going to buy him a couple of weeks of eating. At most. And he, well, he realized that this was it. And he wanted to be at home, surrounded by friends, family, and his church choir buddies. They had made him some pretty amazing smoothies and soups the past couple of weeks. He'd just water it down some more once he got home, but he'd get the nutrients down. Somehow.
I went back to the team room, and told my resident that my patient didn't want the procedure. My resident - deeply unhappy that I hadn't done what I was told - ended up going to talk to my patient himself. I'll never know what happened during their conversation, but my patient went for the procedure two hours later, and came back to his room an hour after that, drain in place. Only to find that it wouldn't drain.
Turns out the "fluid" in his body was actually quite thick. So now IR wanted him to change out the tubing. And at that point, my patient completely refused everything. Everything but hospice. He just wanted to go home and drink his soup.
He left the next day, with my well wishes. But as he left the floor, I couldn't help but be struck by the fact that he was leaving us with a non-usable drain, that he hadn't wanted, because he didn't want to meet God with a line sticking out his stomach.
We want to fix everyone who comes into the hospital. It's why we do what we do. We want to make people better. So when it comes to the point where nothing else can be done, we start coming up with things that could be done. We want to say that we tried everything, that we did everything. But sometimes, the best thing is to do nothing.
It's a hard lesson to learn, and some of us refuse to ever learn it.
