Stream of Consciousness: Hospice

Thursday, May 30, 2013

Twenty Minutes, One Theme, No Edits. Backspace is OK

Today’s Theme: A Visit to Hospice

Ms. S. is a 59-year-old woman who presented to the emergency department two weeks ago with brisk bleeding from her genital region. She had noticed a small amount of bleeding over the past few months, but an underlying condition of paranoid schizophrenia had prevented Ms. S. from believing the doctors during prior hospital visits, when they tried to tell her they were concerned she might have a tumor of the cervix or uterus.

She told me she thought the bleeding was either the return of her menstrual cycle or because of taking too much aspirin.

Over the course of Ms. S.’s hospitalization, we discovered that the tumor had grown large enough to obstruct the outflow of both of her kidneys, causing them to fail, and that it had spread beyond what could be treated surgically or medically. Through several lengthy conversations, Ms. S. started to understand that not only was there a tumor present, but that it would eventually take her life.

Her only known contact was a cousin she had met four times in her life, since her mental illness had contributed to significant strain in her relationships with her siblings. Her flat affect, slowed speech, fixed delusions and incessant tremor had undoubtedly gotten in the way of several of her caregivers knowing that she was a graduate of a top-tier university, a lover of Beethoven and the Beatles, and a close follower of current events in the news.

She was alone the first night she learned her diagnosis was terminal.

But in the days that followed, she was able to reconnect with her brother and sister, whom she had not seen in over a decade, and was even anointed by a Catholic priest before leaving the hospital.

I visited Ms. S. at her hospice home two days ago. When I went into her room, I pulled out a bottle of Evian water and a pint of Bittersweet Chocolate ice cream, both of which she told me were favorites of hers. As she had not spoken much since leaving the hospital, I let her caretakers know about her tastes in music, and I held her hand as we turned on the radio.

Between the sedating effects of the pain medications and the buildup of metabolic toxins from her renal failure, I wasn’t sure how oriented she would be. She answered her own name, the year and her room number correctly before I asked her if she remembered my name.

She looked at me with knowing eyes and said, “Akshay Govind.” She squeezed my hand as we cried together for a few moments, Paul McCartney’s voice playing through the speakers. I sang along, “Michelle, ma belle. These are words that go together well …”