Tuesday, August 26, 2014

facing it

‘Why won’t you come to hospital?’ says Rae, leaning forwards and stroking Rita’s hand. ‘What is it that’s worrying you?’
Rita’s daughter Valerie sobs once, loudly, in the kitchen. After half an hour of fruitless persuasion she suddenly broke down and had to take herself away. Valerie’s husband John passes her another tissue.
Rita is lying on the sofa, emaciated, the worst I’ve seen, her flesh fallen away from her bones like the sea from a wreck at low tide.
Rae has the doctor’s letter on her clipboard, and a note for the crew: Rita has a large abdominal mass that needs urgent assessment. Do your best to persuade - otherwise we need to consider our options. The family have driven half way across the country this morning. They knew she was bad, but this sudden deterioration has been a shock.
‘Rita? We won’t do anything you don’t want to do,’ says Rae. ‘But you’re very unwell and you need your tummy looking at. You’re dehydrated and you’re in pain. We can help with that here, but ultimately you need treatment at hospital otherwise you’ll just get worse. Do you understand?’
Rita licks her cracked lips, but carries on staring up at the ceiling.
‘The hospital won’t keep you in any longer than they have to, Rita. Once they’ve made you comfortable and seen what needs to be done, you can think about what you want to do next. How does that sound? You really can’t go on like this, though. You need to go to hospital.’
Slowly, Rita turns her lustrous eyes on us, and when she smiles, her teeth seem too big for her mouth.
‘It’s cancer,’ she whispers. ‘I know what it is. And if I go to hospital, I won’t be coming out again.’
She gives Rae’s hand a squeeze, as if it were Rae that needed to hear the truth of it and not her. Then she turns her face back to the ceiling.


Lynda Halliger Otvos (Lynda M O) said...

Wow, does that one hit home or what !~! I know of several people who have been "incarcerated" at hospital and never allowed to go back home... I understand the feeling of not letting them get their charts into you and losing all autonomy.

jacksofbuxton said...

Not a lot you can do Spence when someone has made their mind up.

It seems Rita is ready to cross the night ferry.

Spence Kennedy said...

Lynda - That's a powerful expression: 'letting them get their charts into you...' It neatly sums up the fear of being medicalised and disappearing as a person. I think you always do have autonomy, but it's often difficult to hold on to when everyone is telling you something different.

Jack - I'm not so sure she was ready to go. Her resistance looked more like a refusal to admit what might really be wrong - despite the appalling evidence. We were focused on reassuring Rita as much as possible so we could get her to hospital and proper treatment (which sounds premeditated, but we took our cue from the tone of the GP's letter and what the relatives were saying). All in all, pretty difficult.

BTW - she did come with us, thank goodness.

Mary said...

Was this more, wanting to die in the familiarity and comfort of her own home... or associating hospitals with death and thinking that avoiding the one allows you to evade the other?

Spence Kennedy said...

That latter, I think, Mary. It looked as if she was terrified she had cancer (it'd be difficult to think anything else, given the circumstances), and going to hospital was tantamount to 'letting it in'. She hadn't been eating or drinking for some while, so that was making everything worse, of course. Pretty awful for all concerned.

Laura Elizabeth said...

This is something I see so often on my ward :-( patients who have been so scared of the C word that they ignore it until it's too late.

Spence Kennedy said...

It's an awful thing. And I think in Rita's case, the fact that she'd refused to see anybody at home for quite a while really hadn't helped. :/