Friday, November 7, 2008

Too Late

“But it’s too late baby, now it’s too late…” sings Carly Simon from the portable CD player in Mrs. Kent’s room. You might think you are in California as John, her partner of three years or so, tells you about how she has taught him to love nature, to garden, to compost everything that can be composted. He seems to love her, but he does not appear to be feeling the anguish and grief that I have seen when spouses of many years face the loss of their partners. It is more like he is a stranger trying to do a good deed for someone by looking after them- at least in that regard.

Mrs. Kent’s cancer was in remission, but the doctors recommended an extra round of chemo and radiation to try to extend the period of remission. It may have made sense statistically, but the treatments fried her lungs and she was now on her deathbed. You try talking about it with John and he bristles. Immediately you see that you are not the first nurse who has tried this dance. “I am not trying to take your hope away,” you say as you think about how that is exactly what you are trying to do. Sometimes hope is the meanest, cruelest feeling in the world.

There is a copy of a research study in Mrs. Kent’s chart that talks about the type of treatment reaction she is having. If it occurs at all, mortality is 90%. If the patient has to go on a ventilator, death is virtually certain. One of the residents has gone so far as to present John with a copy of the paper. Mrs. Kent is not just on the vent, the pressure settings have been turned up so high that air is seeping out into her chest. You can feel pockets of air under her skin around her collar bones. John talks about how much more comfortable she is now compared to when she first came in. He thinks she is making progress. You try to gently educate him about ventilators. He listens. It is not that he is unwilling to hear. The oncologist has recommended giving her two more weeks to turn a corner. He tells you about his talks with Mrs. Kent before all of this. If there was no hope of recovery, she had not wanted to be maintained artificially. If John’s connection with Mrs. Kent was deeper, would he feel more conflicted? Would he push harder for better answers?

The Medicine team is clearly uncomfortable with what the oncologist is saying, but there are invisible lines that don’t get crossed. Giving John the study paper was definitely pushing the envelope. Where is this oncologist coming from anyways? Is he trying to manipulate survival statistics? Where did the two weeks come from? It does not seem to be based on Mrs. Kent’s condition. Oncologists, as a rule, do not think of ‘hope’ as a dirty word; quite the opposite. Is it possible that this guy somehow imagines that he is doing a good deed?

When the influence of the sedation lightens, Mrs. Kent reaches out in panic and distress. She is clearly disoriented, but she is seeking human connection. Comfort. She might have a lot to say if she could talk, but she will never talk again. All there is to do is turn up the drips. Ah death! The sea of silence!

Care was withdrawn on Mrs. Kent after a week or so. I was off that day.

1 comment:

Lynn Dykstra said...

Hospice joke (very bad taste)
Why do they nail coffins shut?
To prevent the oncologists from trying one more round.