When I was waiting for test results I tried to make up a description in my mind of the consequences of a bad outcome; for myself and then for my wife and my children. For myself it maybe is not too bad - straight to the grave - which is where we all go; even if we think it is too early whenever it comes to that. It is awful, it is difficult to get used to that thought - if you ever are able to…it would be worst for my wife…she is the one who has to take the blow.
When I heard of going to the cancer clinic, I began shivering all over my body. As soon as I opened the door here I felt the smell of the house of death. I can still feel this smell. The word cancer is loaded with fear, I think, and I know some persons who have died of cancer. A tumor is a tumor; uncontrolled cell division, something growing and attacking inner organs.
I react severely to the cytotoxic drugs. I feel so sick, and although I get other drugs to subdue the vomiting, the sick feeling is there, rocking my body all the way. I feel as if I am being run over by a steamroller - my whole body is reacting.
I remember when I woke up from the operation the surgeon told me they had found “islands of outgrowths” in the peritoneum, which was negative news. Something strange happened to me; all anaesthetics and all drugs disappeared from my body, my brain become crystal- clear and I thought: “How can I tell this to my wife?
One of my clinical preceptors always reminded students: “you are allowed to make all sorts of mistakes; but whatever you do, do not kill the patient.” A patient dying while under our care is something everyone fears. How did it happen? Why did it happen? Was it unexpected? What role did we play in it? What could we do about it? It is a major topic of our healthcare system, and the reason clinical teams run morbidity and mortality rounds. After all, if a therapeutic visit ends in death, it warrants a second look. Did we do everything right? Or did we fail?
Now that I am on a palliative rotation however, the metrics of care have changed. There is an understanding that the patients we see are at the final stages of their illness. Our role in this context is no longer to treat, but to make patients comfortable as we allow the conditions to take their course. Our new metric is suffering.
The transition has not been without its difficulties. It is hard to resist the urge to act, to auscultate, to palpate, and to investigate after so many months on the other side of the fence. No longer is death the undesirable outcome, but rather the inevitable conclusion of everyone I see.
In the short time I have been in this rotation, I have already had the privilege to be involved in the concluding days of a number of patients who have since died of their disease burden.
It is a strange and humbling realization that within the coming year, the mortality rate of all the patients I have seen in this rotation will be or close to 100%. And for this service and for everyone involved, that is all right.
Being able to create a great Curriculum Vitae (CV) is an important long-term skill to have. Latin for “course of life,” it is a document that serves to represent you ahead of any formal face-to-face interaction, to tell the story of who you are and what skills and experiences you bring. Thus, making a great first impression on paper is very important.
"Unhook me from these machines. I am going home now and not a moment later."
More than an hour before, I stood by the bedside and watched as the team worked furiously to resuscitate him. Esophageal varices, a cluster of severely dilated and pressurized veins, had been slowly brewing within him over his many years of alcoholism. With the tension of its walls reaching the breaking point, the time bomb had exploded in a torrential gush of blood.