Patient Abiding

When I next arrived at County Hospital, I was glad to see the attending was Helen. During rounds, she explained a lot of medical stuff to us, though she didn’t say what a fungating tumor is. (Maybe she thought we all already knew. Maybe everyone else did know.) That’s a tumor that has broken through the skin and created a wound. A “spiculated mass” was also mentioned. From the internet: “In oncology, a spiculated mass is a lump of tissue with spikes or points on the surface. It is suggestive but not diagnostic of malignancy, i.e., cancer.”

After rounds, Helen sent me to hang out with a certain patient and said she would meet me at that room. When I got there, I learned that the patient had gone somewhere else for a couple of hours, so I stood nearby to wait for Helen. Robert texted me and asked me to see a non-palliative care patient, which I was happy to do, but I didn’t want to miss Helen, so we agreed I would see the patient later. An hour passed. Fortunately, patient abiding (i.e., standing around waiting and no pun intended) is a key chaplain competency.

Helen texted to say she had lined up an interpreter for a patient on a certain unit, so I went there and continued with my patient abiding. Fifteen more minutes passed. I was now starting to get hungry. It occurred to me that maybe the meeting for which the interpreter was needed was not until the afternoon, so I looked at Helen’s text again and was glad to see that it did have the word “now” in it. I never saw any sign of the interpreter, but a Spanish-speaking Eucharistic Minister happened along and we spoke in Spanish, which caused her to think I can speak it, which I can’t. After I confessed that, she kept speaking in Spanish, anyway, which she said is the only way to learn, even if you make mistakes.

After fifteen more minutes (90 minutes of standing), Helen came along and said the interpreter had come, and that I’d missed her. She didn’t sound particularly peeved, but I apologized, anyway, though if the interpreter had come, I wouldn’t have had the faintest idea what room to go into or what to say to whomever was in there, anyway.

Helen lined up another interpreter and we went to visit a patient who was on comfort care, with a number of family members present. His breathing was a bit labored, so Helen helped to turn him on his side, which she said would make his breathing easier, and she described other kinds of breathing the family might see as death approached: shallow, rapid breaths; long pauses. She pointed out the wet breathing sounds he was also making, and said that this is not uncomfortable for the patient, though it can be uncomfortable for his family to listen to. She said it would be fine to moisten his lips with a wet sponge, or to put Vaseline on his lips, but to make sure not to let any water drip down his throat, because that would cause him to feel uncomfortable.

(I asked her later why water makes the difference between comfort and discomfort when one already has wet breathing and she explained that the gunk that causes the wet breathing is up in the throat, whereas aspirated water ends up in the lungs.)

The family asked how long she thought their loved one would live, and I think she said days to weeks, or maybe she said hours to days. (That is always how doctors express life expectancy, in my experience: one unit of time to the next unit.)

Next I found myself in another patient’s room with the same interpreter and a doctor who had the patient’s test results. Helen was delayed somewhere. I sat down on the low, wide windowsill, but then realized the patient was about to find out she had cancer, so I joined the group. The doctor said, “I have your test results. Do you want to hear what they are?” Some people don’t, particularly in certain cultures. The patient said she did want to hear.

I have many times heard doctors discussing a patient’s condition with him or her, but I have never been present right when someone learns she has a terminal illness. The patient’s head rocked back and her eyes shot wide open. Her relative in the room (who filmed the entire conversation on his phone) said, “Well, those results aren’t conclusive,” and the doctor had to emphasize that the results absolutely were conclusive. The patient has metastatic cancer; the only thing not known was where in her body it originated.

As it happens, this patient was here visiting from her faraway home country and she is old. When she said, “I can’t go home, I can’t go home,” I nearly burst into tears myself, thinking of my beautiful green home state. What if I were to die before I saw it again? That was the most upsetting thing that happened all day. Helen had joined us by then and pointed out that it was lucky that the patient was going to spend this part of her life (i.e., the end of it) here where her children are, and I believe that was indeed the most important thing to the patient. Helen then worked with the patient’s son to get a POLST form signed, and went off to arrange for a local hospice to care for the patient on a charity basis, since she doesn’t have insurance in this country. (The hospice did agree to this.)