A tribute to a palliative patient

By Priya Selvaraj

Laura glanced down at the next patient’s details. There wasn’t much to start with – she had never met this gentleman before, and we were just going to “drop by and check in on him”. We had taken a moment outside his house in the hospital car as she explained to me that the patient we were about to see was currently receiving palliative care for his cholangiocarcinoma. And that’s the extent of what we knew about him. As we stepped out of the car, a pleasantly dressed elderly man opened the door and waved us in. Introductions were made, pleasantries exchanged and we went in.

I was in my second year of medical school, following a nurse out during a Hospital In The Home (HITH) session as part of my two-week rural placement. It is important to note how inexperienced I was in my medical journey at this point – essentially a scared, trembling fawn. Bambi had nothing on me. Insecurities loomed constantly, a general feeling of incompetence prevailed. Regardless, I was enjoying myself during the HITH session. We drove around Bairnsdale and Lake’s Entrance, checking in on patients, mostly elderly – changing dressings, checking their PICC lines, replacing their medication supply, and so on. But the one person whose memory I still hold on to dearly is Sal.

Sal’s home was a cosy little place surrounded by a well-maintained garden. The octogenarian himself looked young for his age, and on first impression he was fit and mobile. He was silver haired and wore a sharp sweater-vest, looking altogether very dignified. As we sat around his dining table, his Russian Blue leapt up onto his lap obediently. The fat, grey haired cat snuggled in, seeming really quite pleased with himself. Smug little bastard.

Laura began by asking Sal how he was coping at home and he replied with impressive stoicism. It was going well, he said, all things considered. In fact significantly better ever since he had stopped chemotherapy.

When Sal was first diagnosed with cholangiocarcinoma, it was clear that he didn’t have much time left. “A few months, to be exact”, he added. He had gone through surgery, followed by numerous cycles of chemotherapy, each one more unbearable than the last. He recalls his final round, sitting up on the edge of the bed – an action in itself that caused much pain – and telling his doctor to “please just stop”. The effects of the treatment were too much.

At some point in the conversation, Laura had forgone her medical notes and set her pen down. She enquired about his family – did he see them often? Sal nodded, immediately regaling us with tales of his grandchildren, all of whom he was very proud of indeed. He saw them every weekend, and kept himself occupied throughout the weekdays.

Sal didn’t let anything stop him from doing the things he enjoyed. Once a week, he volunteered down at the local Men’s Shed. He spent some time gardening everyday. And as if that didn’t keep him busy all the time, he was also building a wooden playhouse for his wonderfully devoted cat, which never seemed to leave his side. His excitement and passion was infectious.

I wish I could tell you that Sal’s story gave me an epiphany that helped me understand human struggle and endurance. He did, without a doubt, move me – the tears I held back in my eyes flowed freely the moment I got back to Laura’s car. I felt bitter really, at how such a thing could happen to a person like Sal. But I’ve come to realise now that there are a thousand–  no, a million stories like Sal’s. In fact, there is no way I could possibly comprehend and articulate the devastating consequences of terminal illness. Surely, many other doctors, patients, and those who have lost loved ones have and will continue to do a better job at telling those stories than me.

But to me, Sal’s story has also served as a springboard to explore ideas about the purpose of medical care, especially when death is an inevitable and imminent factor. Almost a year later now, I’ve had the opportunity to do a rotation at a palliative care facility. After being exposed to numerous patients with stories similar to Sal I’ve become fascinated with the concepts of autonomy, palliation, and death. Once we are forced to accept that all of medicine only aims to delay death, what is truly the goal for treatment? What should be the litmus test for good medical care? Is it a life “well lived” or a “good” death, however subjective that may be? What I do know is that, during my rotation, test results and numbers began to fade and I became acutely aware of each patient’s unique experiences and wishes. A palliative care physician’s primary question to the patient is, “What are your goals with regards to your care?” Shouldn’t holistic and allied health then be one of the hallmarks of medicine instead of an afterthought to be rattled off by medical students in an OSCE station?

As we were about to leave, Sal showed us the unfinished playhouse for his cat, a complicated design with tunnels and towers. With a warm smile and a firm handshake, he wished me luck with my studies. As we drove off, I watched his silhouette on the car mirror become smaller and smaller before vanishing entirely.

All names in this article have been de-identified.

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