Treating a patient who doesn't want to be fixed
There’s a patient at the hospice who makes me feel uncomfortable.
Henry is 76 years old, and has pancreatic cancer. He came to us from hospital, with a haemoglobin of 52. He feels a bit washed out, as you might expect. But he doesn’t want us to do anything.
Here at the hospice, a patient like Henry might have a blood transfusion to help with his symptoms, and we could support him to get back home. I’ve challenged my own misconception during this rotation: that when we hand out ‘palliative’ label, we nudge a patient into a stream of medicine where all intervention is withdrawn.
But each day on the ward round, Henry resolutely refuses everything. And he has capacity to do so. I find myself somewhat uncomfortably twiddling my stethoscope at the end of his bed, as he politely ushers me away so he can get back to watching Jeremy Kyle. His words follow me out of the room: ‘I’m ready to go now Doc.’
I stand outside the door of his cubicle each day, letting the discomfort percolate slowly through me. And then wonder why he makes me feel this way.
The last few months have opened my eyes to a speciality I knew little about. To start with, I’ve begun to appreciate what it actually means. In particular, as the WHO explains, it ‘intends neither to hasten or postpone death’, but ‘improve the quality of life of patients and their families facing the problem associated with life-threatening illness’.
At medical school, I don’t recall learning much about palliative care. After all, doctors are meant to keep patients alive, to treat them. I don’t remember many lectures on tending to their demise. Health meant the presence of disease, and our job was to eradicate it or keep it at bay. And the way I saw it, a patient’s death declared a failure in that task.
But Henry changed things. I’ve come to realise that my satisfaction in being a doctor stems from a feeling of competence, and that means feeding the urge to fix what’s in my control. But Henry doesn’t want me to fix him. He wants me to listen.
Dr Nishma Manek is a GP trainee in London.