Tuesday, December 09, 2014


Anyone could tell walking into that room that Adnan is mortally sick. His massive figure is sprawled helplessly on the bed, pale and sweating, a CPAP mask over his face. But if you missed the signs, the long list of acronyms on the discharge summary would make it plain in an instant: CKD4, CBBG, IDDM, CCF, AF, OSA and so on – a long, coded parade of woe with an eloquent line-space before the final four letters: DNAR. He was only discharged three weeks ago, but he’ll need to go back. He’s struggling with chest pain and breathing problems, and the family simply don’t have the resources or expertise to cope at home any longer.
Adnan’s son Bashir tells us what we need to know, translating into his father’s ear, and gripping him by the hand. Adnan’s wife, Rema, meanwhile, comes in and out of the room with a succession of things: a clean pair of inco pants, a fresh linen robe, some velvet slippers, solemnly handing each item to us with such a fixed and sad expression it feels like we’re officiating in some religious ceremony – which, by default, I suppose we are.
Together with Bashir we dress Adnan, and prepare him for the ride in our chair out to the ambulance.


Once he’s on the trolley we run through another set of obs. We need to do an ECG, so I undo his robe to the navel. Lying on top of the great, bunched scar that runs down the centre of his chest is a plain wooden cross on a chain. I hesitate to move it aside. It strikes me it’ll probably do him as much good as anything else Still, we go through the motions, sticking on dots, putting in a canula, giving morphine, working around each other in the cramped cabin space.
Adnan groans.
Bashir sits forward on his seat, squeezing his father by the hand and talking low and quickly.
Okay. Good to go?’ says Rae finally, surveying the scene and pulling off her gloves.
‘Yep. Thanks Rae. I’ll pass the ASHICE from the back.’
She jumps out and slams the door.
I press the Priority button and wait.
Bashir leans over, repositions the cross on his father’s chest, strokes his face, then sits back down again as the ambulance moves off.


jacksofbuxton said...

Another tough one Spence.

It's probably hard enough for a family to cope with the final chapters as it is,never mind asking what each acronym stand for.

Anonymous said...

What an amazing thing to do, treating people with such care and dignity.
Well written as always, plus great names

Spence Kennedy said...

I think they had enough of an idea what was wrong, Jack - heart bypass, diabetic, kidneys not working properly, that kind of thing. They all seemed quite prepared in many respects, even if the finer points were beyond their understanding (and mine, come to that). A lovely family - really supportive & caring. And even though it was the most stressful time imaginable for them, still very kind and polite to everyone else.

We do our best, Anon. It's easy for those human touches to get forgotten in the rush for medical treatment. And if they do get forgotten, it's only ever because the situation is just too demanding in other respects. Cheers for the comment!

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

What love is shown and how well you describe it. My mom went in Jan with a list like that at nearly 80; Dad followed in May-been a rough year in the dying portion of life; thanks for the living. And for you, Spence, for this blog and all that you do for your patients. I hope my folks were treated as well when their time came.

Spence Kennedy said...

Hi Lynda - So sorry to hear about your mum and dad, and that they were so unwell with multiple illnesses when they died. The capacity for the human spirit to battle on regardless is awe-inspiring. I hope they died peacefully, with as much care and attention as possible. I know that amongst my colleague the vast majority will make huge efforts to maintain & protect their patients' dignity, often in challenging circumstances. I suppose at heart it's because it's what we'd expect for our own families, and ourselves.

Thanks so much for the comment, Lynda. Hope all's good with you & yours today.