Posts tagged narrative

The Struggle

For weeks, a patient had been ambivalent, struggling with the decision between full medical care or comfort care only. It was only a matter of time between the disease would make that choice for her.

Everything we could do to prolong her life had been done. There was no process left to reverse. The disease was reaching its ultimate conclusion. With great reluctance, the patient agreed to comfort care.

It pained me to see her struggle because I knew how much it chewed her up inside, to leave behind her family and friends, to be confronted with the threshold of death. It was obvious she loved dearly and was dearly beloved.

I saw her briefly again today after finishing my rounds, passing through our hospice. After seeing her struggle for so many weeks with this decision, I was relieved to find her smiling, having finally found peace in these last hours, surrounded by friends and family. As they gathered to look at old photo albums and share stories under the warm winter glow, her eyes flickered with joy as she laughed with her grandchildren.

For a moment, our eyes met as she caught a glimpse of me by the nursing station. Quietly, we acknowledged each other.

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?

An excerpt from Expressive Metaphors in Cancer Narratives by Carola Skott, PhD RN.

The Bleed

"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.

The Last Meeting

In the quiet conference room overlooking the hospital atrium, we sat down with our clerkship site director for the last time to wrap up some loose ends. It was here, less than a year ago, that we gathered for the very first time as a group to discuss what the rest of the year would entail. Now, we had come full circle, gathered to reflect on our experiences, our growths, and our recommendations for improving the experience for the incoming crew.

For a moment, it seemed casually regular, like our typical weekly sit downs. That feeling was broken when the director closed with some heart felt words that hit home the thought that by the turn of this week, this group will be disbanded and a new class will assemble in our stead.

"I congratulate all of you. You all worked very hard this year and you have come so far. Congratulations on surviving third year. Good luck to all of you on your future endeavours and on your final year."

We looked at each other in nostalgia, at the memories we had collectively collected within these walls. There would be no more small talks with the staff, no more late night walks through empty halls, no more patients to follow up. Though I looked forward to my two weeks off, the thought still made me feel hollow like I had lost a part of myself.

After a brief conversation about handing in our paperwork, logs, and badges, the meeting was over and we were set free. The director came around to shake all of our hands before departing with a final farewell and invitation.

"I will see you when I see you."

Slipping Away

The room was dark and heavy with a burden of a deteriorating situation. On a bed, the patient lay. His breathing sounded difficult as he tried to suck in air hungrily from his slack mouth. The eyes stayed closed even as we walked in and greeted him. The body remained perfectly still. 

For a moment, it would have been easy to imagine that perhaps this patient was sleeping; from afar, the stillness would have caused alarm. However, it was not death we were dealing with, at least not yet. As he made that slow and painful transition to that final destination, less and less of his body responded to his commands. Soon, he would lose even more functions vital to life.

Not two weeks ago, the man had been walking, speaking, eating. On our visit, all of that had changed. The nurses painted a grim picture: His terminal illness had accelerated and the man was on a downward spiral. We expected no more than two weeks.

"Are you having trouble breathing?" the doctor asked, giving him a simple binary choice.

"…H…H…Hard," he managed to whisper with tremendous difficulty.

And so went our assessment as we tried to improve his comfort. I observed as the doctor asked questions and explained the situation to the patient. He was once a very strong and independent man, husband, and father. Now he was reduced to a shadow of his former self, trapped in an ever weakening body beyond his control and beyond our capacity to cure.

His life was dictated by his disease progression now.

In being in that room, I felt a helplessness in the same way that I imagined he felt as he lay there at the mercy of his affliction. I wanted to help him so badly. I wanted to reverse the progression and turn back the clock. I wanted to give him answers and solutions. But the truth is that is never always the case and certainly not this time. 

The doctor got up and said a few parting words as he left the room. For a moment, it was just me and him, alone. I tried to reassure him, but could not find the right words. Again, I stood there listening to his laboured breathing. I finally reached for his hand and gave him a gentle squeeze.

"Take care. And thank you," I said instinctively as I too left.

That was the last time I ever saw him.

More time than we could handle.
The other day, something very unusual happened: we had more free time on our hands than available work. The day was already off to an atypical start when the patient list fit onto a single page as opposed to the usual two. While rounding, it soon became clear that many of them would be discharged, leaving little in terms of in-house management.
"Perfect!" said my preceptor. “We will go to the hospice then and review our patients there." And so we went, having finished early. A typical morning seldom included the hospice round because of time constraints. This day we were lucky. 
We arrived on site to find: only one patient issue. Total time of management: ten minutes. Yet again, we were stuck. My preceptor scratched his head as he sifted through his planner. There was nothing to do for another two hours.
In a career where there never seems to be enough time, we suddenly found ourselves with more time than we could handle.
"Well this is awkward," he commented almost disappointingly. “Shall we go for coffee then?"
And so we sat in a Starbucks and caught up on life, the universe, and everything. There was an otherworldly feel to the morning, an uncomfortable ease as we tried to relax into our seats. Threaded through the eye of the medical storm, we tried to enjoy a moment of downtime but could not, knowing there was more work to be done, more work waiting for us, helpless to the time that separated us from it.
Sitting there, I wondered if we were truly lucky to have had time to sit and talk. I wondered if medicine suddenly found itself with more moments like this, would it drive doctors mad? 
How wonderfully odd creatures we are to thrive on the fast track life of our work.

More time than we could handle.

The other day, something very unusual happened: we had more free time on our hands than available work. The day was already off to an atypical start when the patient list fit onto a single page as opposed to the usual two. While rounding, it soon became clear that many of them would be discharged, leaving little in terms of in-house management.

"Perfect!" said my preceptor. “We will go to the hospice then and review our patients there." And so we went, having finished early. A typical morning seldom included the hospice round because of time constraints. This day we were lucky. 

We arrived on site to find: only one patient issue. Total time of management: ten minutes. Yet again, we were stuck. My preceptor scratched his head as he sifted through his planner. There was nothing to do for another two hours.

In a career where there never seems to be enough time, we suddenly found ourselves with more time than we could handle.

"Well this is awkward," he commented almost disappointingly. “Shall we go for coffee then?"

And so we sat in a Starbucks and caught up on life, the universe, and everything. There was an otherworldly feel to the morning, an uncomfortable ease as we tried to relax into our seats. Threaded through the eye of the medical storm, we tried to enjoy a moment of downtime but could not, knowing there was more work to be done, more work waiting for us, helpless to the time that separated us from it.

Sitting there, I wondered if we were truly lucky to have had time to sit and talk. I wondered if medicine suddenly found itself with more moments like this, would it drive doctors mad? 

How wonderfully odd creatures we are to thrive on the fast track life of our work.

Words Never Spoken

A man struggled with severe depression and suicidal ideations for many years. No amount of counselling, medication, and therapy could lift him from the bleak depths of his own personal hell.

He had been involved in the loss of a life. On a dark and rainy night in the summer of yesteryear in a far and remote place, a car barrelled through a stop sign into his own. He was hurt, but she was gravely wounded. Without phone reception and without a soul in sight, he carried this stranger with him on that lonely road hoping to find help, to find anyone. In that darkness, the stranger died.

Racked with guilt and a sense of helplessness, he spiralled into depression with a burden of having not saved this person from their fate. Every night, the nightmares came; every night, he failed to save her. It was agony. 

One day, the doctor tried something new. “I want to you take control of your dreams. Think of new endings to that moment. Let your thoughts carry themselves into your dreams. Change what happens.” The man was puzzled. “Perhaps imagine yourself to be Superman. Fly her to the nearest hospital. Maybe dream up an ambulance.” The man was hesitant to try, but decided with everything else they already did, what was the harm in trying? 

"You do not recognize me, do you?" A stranger said to the doctor one day at a coffee shop. He looked up perplexed but suddenly recognized the man he had seen those many months before. It surprised him. The man was smiling, well kept, and spirited. The difference was night and day.

"What happened?" 

"It worked, doctor. Your dream therapy worked for me. Thank you."

"Did you save her in your dreams? Was that what it took?"

"No. I was never able to save her. But one day some months later in my dream, carrying her as I always did down that lonely road, I heard words she never spoke, but words that helped to give me closure."

"What did she say to you?"

"Thank you for not letting me die alone."

Breast Cancer Survivors Find the Michelangelo of Nipple Tattoos

In the waiting room of Little Vinnie’s Tattoos, bikers and punks sit side by side with church-going grandmas and soccer moms. Customers fly in from as far as Saudi Arabia, Spain, and Brazil, to an unassuming strip mall just outside of Baltimore complete with tanning salon, liquor store, and adult DVDs. Anxiously, they enter Vinnie Myers’ shop, the final destination for many breast cancer survivors attempting to recover what mastectomies have stolen away.

For all of medicine’s advances, the best option for areola reconstruction is tattooing, and in the field of cosmetic tattooing, Vinnie’s trompe-l’oeil “areola portraits,” as he calls them, are widely regarded as the best that money can buy.

Read more…

A Rookie Cut

Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.

Slowly, over time, he had begun to learn the tools of the trade - the different scissors and the brushes; the straight razor and the strop - and began to practice on the dummy heads.

Today, I went to the barbershop to find him cutting what must be his first set of heads full of hair. All the while, he was receiving pointers and tips from my barber, his father.

His eyes were focused, his body was tense, as he trimmed the weight from the man’s temple. Snip. Snip. As the locks fell to the floor, he re-examined his work. Was it too little? Was it too much?

“Remember to angle your brush up. It’ll give you more room to work with,” his father would say, and he would oblige and try again, with more angling of his left wrist. In the end, the older man seemed satisfied with the young man’s work. A sizeable tip came the trainee’s way, to which he hurriedly returned to the man.

“The cut is free. I’m still practicing.”

“You’re always going to be practicing. Besides, you’ve earned it. Keep the change.” The customer gathered himself and took his cane as he thanked the barber in training yet again. The young man was pleased.

“Next?” Of all the people waiting in the barbershop, no one took a second glance.

“Does your son know what he’s doing? I mean it’s a rookie cut,” came one snappy customer. No one moved. They wanted the expert, the experienced barber, the man who knew every bump under every patch of hair on their heads. They wanted his father. The brilliance of the man’s eyes that a moment ago seemed so alive, dulled. He put down the gown and reached for the broom.

“Sure, I’ll go,” I said, taking up his offer. He gave me a smile and motioned me to the chair. “Have a seat.”

I understood his plight. We were all in the same boat together. As learners, we depend on the good will of the people we see for us to gain experience, to be better, to become professionals. The process must start somewhere. It was time I returned this favour to another student.

“Caesar trim. Sides short. Front long,” his father called out.

“Hey.”

“Hello.”

“Thanks for giving me the opportunity.”

“No problem. We all have to start somewhere.”

Death surrounds us.
Recently, I have had many emotionally exhaustive shifts at the hospital. Some of my patients looked well; others did not. Regardless, many of them have died under my team’s care.
We are all destined to that outcome one way or another. In that sense, perhaps it was meant to be - the diseases had progressed too far or the patient could not carry the burden any longer. But my mind lingers on the life that escaped with their last breath, on the last dying days where my life had become intertwined with theirs.
My mind races and wanders to what could have been. Had we done enough? Did I do something wrong? If I had seen them a few hours earlier, could I have found a sign of the impending end? Could I have then given the patient and their family a few more precious moments together? 
Despite my meticulous combing of the chart, I could never find the answers to these questions. We had done everything we could.
In the hospital, death surrounds us, ever hovering in the air, lurking behind every chest pain, kidney failure, and fever. Though we make advances everyday, Death always gets the last word. 
"I’m sorry we could not do more," I once said to a rapidly deteriorating patient.
"It’s alright. I know you guys tried. I’m grateful for everything. We gave it a hell of a run, didn’t we?" He mustered his fading energy to form a smile.
"Yeah, you sure did." We shook hands for one last time.
"I’m ready."

Death surrounds us.

Recently, I have had many emotionally exhaustive shifts at the hospital. Some of my patients looked well; others did not. Regardless, many of them have died under my team’s care.

We are all destined to that outcome one way or another. In that sense, perhaps it was meant to be - the diseases had progressed too far or the patient could not carry the burden any longer. But my mind lingers on the life that escaped with their last breath, on the last dying days where my life had become intertwined with theirs.

My mind races and wanders to what could have been. Had we done enough? Did I do something wrong? If I had seen them a few hours earlier, could I have found a sign of the impending end? Could I have then given the patient and their family a few more precious moments together? 

Despite my meticulous combing of the chart, I could never find the answers to these questions. We had done everything we could.

In the hospital, death surrounds us, ever hovering in the air, lurking behind every chest pain, kidney failure, and fever. Though we make advances everyday, Death always gets the last word. 

"I’m sorry we could not do more," I once said to a rapidly deteriorating patient.

"It’s alright. I know you guys tried. I’m grateful for everything. We gave it a hell of a run, didn’t we?" He mustered his fading energy to form a smile.

"Yeah, you sure did." We shook hands for one last time.

"I’m ready."