Tag Archives: blessed

The Expiry Date

This morning I read drkategranger’s blog regarding her expiry date (she is a doctor with terminal cancer who talks about death so candidly, it inspires. I would absolutely recommend!!!). The blog and some of the responses to it got me to thinking about death. I have already written about dying and the fact that I fear it not so much. As a Muslim, I tend to see death as just one of those certainties of life so I treat it quite matter-of-factly. This blog is will be further musings about my experiences of death. I will start with a quote from Hadith (Islamic teachings) which summarises how I generally see life and death:

Al-Hasan Al-Basrî said:
‘The life of this world is made up of three days: yesterday has gone with all that was done; tomorrow, you may never reach; but today is for you so do what you should do today.’ Al-Bayhaqî, Al-Zuhd Al-Kabîr p197

I am generally an optimist or more accurately an optimistic realist so I try not to be morbid and I am generally not one to dwell on death. However, I have had times in my life where the thought of dying has crossed my mind. Last winter was a pretty bad time for me. I was working in the hospital that inspired me to become a paediatrician (which still inspires me) but I was in a job with a particularly toxic individual who succeeded in poisoning the atmosphere. I became depressed after 6 weeks of this. So much so that I hated waking up every morning I was scheduled to work. It got to a point that I would lie in bed, sleepless and think ‘would it be that bad if I didn’t wake up in the morning?’ As soon as the thought came to my mind, I would feel guilty and terrible. Guilty because I knew that my life really wasn’t that bad and that there was so much for me to be grateful for. Terrible because I knew my death, although insignificant in the grand scheme of things, would be horrible for my nearest and dearest. My mama especially. I got through those 4 months because my husband was there and would not let me sink into the depths of depression that kept pulling at me. Thank you George!

I am now back to my normal sunny self despite some current work horrors. As a newly-qualified doctor back in 2009, I dealt with death day in, day out especially on my first job on gastroenterology at a busy inner-city hospital. After the initial shock, I got used to it. Not that I didn’t care or it didn’t bother me but I dealt ok with it. There are 2 patient deaths from those days that have stayed with me. Both died of alcoholic liver disease. Both men in their 40s.

The first patient died slowly from hepatorenal syndrome (HRS). Basically with chronic liver failure, if your kidneys too fail, you will die soon because that means 2 of your 4 vital organs are dead or dying, unless you get brand new organs (i.e. transplants). As things currently stand, you cannot be put on the transplant list for a new liver if you are still abusing alcohol because the new liver will get damaged just the same and it is considered a waste of an organ that is in high demand but short in supply. So with my first patient, who I will call Patient A, when his kidney function tests declined rapidly and nothing we could do medically fixed it, we diagnosed HRS and my registrars and consultants had a meeting with his wife to inform her of the diagnosis and what that meant for the patient. He too was told in due time but because of his liver failure, he was confused and did not fully grasp the fact that his condition was terminal.

He deteriorated slowly over a few weeks but in the meantime, he would ask me daily when he could go home and travel to India to be blessed in the Ganges River. I would mutter something non-committal and beat a hasty retreat out of his side room. Initially, it was clear that his wife knew his death was near. But even she began to belief he would miraculously recover from his liver and kidney failure. Every week, she would say something that made us worry we hadn’t prepared her for the inevitable. Every week we would remind her gently that although she couldn’t see it, he was in actual fact deteriorating judging from his biochemistry lab results and worsening oliguria (he was weeing less and less).

In the week of his death, he suddenly looked well again. If I wasn’t the doctor patiently doing bloods on alternate days and chasing those results and noting the relentless rise in his urea and creatinine, I too would have started to believe in miracles. His wife upon seeing the light return to his eyes and his demeanour brighten plunged headlong into denial and joined him in planning their trip to India to the Holy Ganges River. Less than 24 hours before his eventual expiry date, it was devastating for me to watch her grief as the light in his eyes faded rapidly and he shrunk back into himself. Within 12 hours of his final illness beginning, his strength was gone and his mind with it. His utterings became incomprehensible and he became completely disorientated. The look on her face said it all when we came in to see him on our ward round that morning. We returned the look and she ran out of the room to sob in the corner. He was anuric by then (had stopped weeing completely) with a creatinine of over 400 (in other words, his kidneys had packed up). His liver function tests painted an equally damning picture. We completed his end of life paperwork that morning and when we left work that evening, he was hanging on by the tips of his fingers. We came in the next morning to the news that he had died before the end of the day before. The side room he had occupied for many weeks stood empty, awaiting its deep clean before the next customer.

Patient B was a young alcoholic who had developed liver cirrhosis in the months before I started the job. He had just turned 40 and I don’t think had any idea how serious the consequences of regular alcohol binges could be. Reality hit when another patient who was his ‘neighbour’ on our ward developed HRS and died rather quickly. All of our words of warning had somehow not sunk but with this other patient’s death, his mortality was clear to him. He called me over urgently that afternoon and said ‘Doc, I am ready to change’. I was pleased and felt a sense of accomplishment when I referred him to the rehabilitation programme. His wife found me the next day before they were discharged home to thank me for getting through to him. I was honest to say it wasn’t anything I did.

Unfortunately, he came in a few weeks later unwell with an infection which caused his liver function to deteriorate badly. I was encouraged to hear that he had no touched a drop of alcohol since his last admission. He developed litres of fluid in his tummy and I had to put in a tube into the side of his tummy to drain out all that fluid. He was in a lot of discomfort and fearful for his life and he asked me ‘Doc, am I going to die?’ I hesitated over the words I used but in the end I made no promises. Just that I would do everything I could to help him get through this. At first, it looked like the drain and intravenous antibiotics were effectively doing the job and the next day, the fear was gone from his eyes. I was encouraged by his blood results and left having ordered some more routine bloods for the next morning. Coincidentally, at I was securing his abdominal drain, I carelessly dropped the needle I was using to suture and when I went to retrieve it, gave myself a needle-stick injury. I had to get a co-doctor to inform him and take blood samples off him to check that he didn’t have any blood borne infections I could catch. He apologised every day after the event like it was his fault I had stuck myself with a contaminated needle. He asked me about those results daily – he seemed genuinely to care for my welfare. This went on for over 2 weeks as he slowly improved.

I was doing the ward round alone one morning when I was called urgently to his side. He was in a great deal of pain and was writhing in his bed with his abdomen larger than before we drained him. He was pale and clammy and his eyes looked like a man staring down the barrel of a gun. I could barely make sense of his words and as I changed his prescriptions, called the blood bank for blood products and prepared to get a new drain inserted. I could see the life begin to ebb out of his eyes. In a panic, I called my registrars and told them I needed them on the ward ASAP because patient B had taken a turn for worse and nothing I was doing was making a difference. The registrar told me to leave the drain for the meantime and focus on reassuring the patient. After I asked the nurses to call his wife in, I went to him and I held his cold hand. I looked into those eyes and I knew in that instant that he was not long for this world. I remember saying a mental prayer that he could hang on for his wife to be by his side.

‘Doc!’ he cried. I squeezed his hand and responded ‘Yes B?’

‘I am dying aren’t I?’ he asked. I looked down and swallowed the lump in my throat. ‘I am here for you B and I will do everything I can to help you. Your Mrs is on her way in.’

‘Stay with me,’ he entreated fearfully. I nodded and again I had to look away because the fear in his eyes was too powerful for me to take in. The rest of it was a blur. His wife made it in before he died but not in time for him to know she was there. He was delirious by the time she got to the ward and as he was slipping away before our very eyes, there was little time to have ‘that conversation’ with his wife. The consultant whisked her away and broke the news to her. She could see that treatment was futile by then and knew that he was on maximal available medical treatment. We had no more to offer. She signed the DNAR (do not attempt resuscitation) forms and we set about making him less agitated. When we finally called it a day, he was less distressed, still mumbling incoherently and his eyes had started to take on that distant look I now associate with death. I came in the next morning to a request to come to the morgue to complete his death certificate and Crem forms so that his wife could lay him to rest. I got a call 3 days after his death to say his blood tests for blood borne infections had come back negative so I was in the clear. I cried in the staff toilets. He would have been relieved not to have put me at risk I think.

What did patients A and B teach me about death and dying? Firstly that when it is your time to go, it is your time to go. Life unfortunately doesn’t usually give you a clearly labelled package with an expiry date on it. Secondly, although death is scary for the person dying, it is actually worse for the person who loves them who has to watch them lose their battle to live and battle their fear of the unknown. Who has to go home and face life without them and rebuild their lives around the hole left by the dead loved one. Who for a very long time will think about their dear departed every morning when they wake up and every night before they fall asleep. Lastly, every human is unique. Despite having the same disease and modifying your risk factors, your body will do its own thing. We doctors can try to influence outcome but whether we succeed or not is not within our power to control. That is beyond science and medicine. That is life. That is God. That is reality. May we all depart this world in the easiest swiftest way possible. Amen

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Corazon Por Corazon

I speak very little Spanish but being a salsa fan, I have heard enough Spanish lyrics to know the Corazon means heart and the Spanish-speaking world is always ‘Corazon this’ and ‘Corazon that’. The title is a nod to the video I just watched on Facebook which has inspired this piece. It was posted by Andre Gayle who has stuck English subtitles on a Spanish video entitled Corazon por Corazon (heart by heart…changing the world). Basically, the video is about the loss of our humanity, the very essence that is supposed to make us superior to other animals and plants. It highlights what cruelty and sadness there is in the world and how a lot of us are desensitised to the sight of another human in need. So much so that when we witness suffering, many a times our response now is to take out our smartphones and take a video instead of offering our help.

It made me cry, especially the scenes of animals and children being abused. It made me ask ‘why’ again. I am the half full glass type of a girl but occasionally, I become despondent when I watch the news and it is full of pictures of little children being bombed by Israel or another old pensioner being abused by a carer. It makes me question what I am doing spending so much of my time doing NHS/eportfolio paperwork when there is suffering out there and I have the medical training to perhaps make a difference to so many, in Nigeria for example. It makes me question whether having children is a good idea because what legacy are we leaving behind for them to inherit?

The environment is a huge worry for me. I drive a Nissan Leaf in an attempt to be greener and I recycle and try to minimise waste. I know my efforts mean something but are probably insignificant in the grand scheme of things but at least having made the effort, I go to bed with a clearer conscience. For every person who drives a ‘green’ car or cycles or walks, there’ll be 10 people who drive cars with ridiculous amount of emissions, who waste more than half the food they buy and who never do any recycling. As the ozone layer thickens and the greenhouse effect is compounded, global warming intensifies. Formerly temperate climates develop extremes of weather. Flooding, draughts, tsunamis, tornadoes, forest fires and earthquakes occur with greater frequency than ever before. Large populations of the world who are dependent entirely on subsistent farming are living in famine conditions year after year. Ironically, in Europe and the US more and more of the population are buying excess food and every week are binning it as they buy too much and let it all go to waste. Too much of land is taken up by refuse which no one knows how to get rid of properly. Mountains of waste piling up as we become more and more wasteful. Turns out that even our recycling is not all recycled. Because our Governments have not invested enough into recycling plants so only a fraction of the potential recyclables are being  recycled.

Kindness is becoming short in supply too. As the video highlights, it is now commonplace to watch a person being beaten, robbed or even stabbed and no one wants to step in because it is all about protecting the self. Every year, there is someone on the regional news who has been stabbed or mugged in a bus or at a bus stop or somewhere similarly public where everyone has just stood by and watched. Yet some of these people have the audacity to whip out their phones and video the event and then post it on YouTube. I always wonder how these onlookers would feel if the victim was not a stranger but their mother, father, brother, sister, daughter, son or best friend?

As for the violent offenders, many of them are children who are old enough to know between right or wrong but even at that early age, they seem hardened and lacking in the most basic of human kindness. I know this lack of kindness and empathy is multifactorial but I am convinced one of the main reasons is poor parenting that comes with the modern time. As a paediatrician, I am in a privileged position to be able to closely observe the intimate relationship between parents and their children. There are many things we see that cause us to raise our eyebrows and a few that send us running to Social Services. But what I find most disappointing is when a young child aged 3 or 4 does or says something cruel and the parents, instead of taking the opportunity to point out what is right or wrong and explain why, turn their faces away and throw away the chance to shape their child into a decent person. A couple of weeks ago, I was on-call and went to see a 10 year old boy who was in pain with my registrar (senior to me) and an ST1 (junior to me). The registrar examined him and decided we needed to investigate by taking a blood sample. The boy’s reaction was to shout ‘You are not f*****g touching me. I will bash your f******g head if you come near me’. What did his father do? He bowed his head and my registrar shot the top of the dad’s head a look. As more swearing came forth, I stepped closer to the boy and said firmly ‘I’m sorry you are scared of having a needle but you are not allowed to speak to us like that. We are here to help you.’ That stopped him in his tracks and he resorted to sobbing. His red-faced dad followed us out of the cubicle to apologise and all I could think was ‘don’t apologise to us, teach him to have a bit more respect.’

Speaking about respect, I think that has run off with the kindness. As doctors, we are at the receiving end of a lot of disrespect but we put up with it because we understand when people come in contact with us, it tends to be the most stressful, frustrating, unhappiest time in their life. I think a little respect goes a long way. It is in the small things like saying sorry when you barge into somebody, holding open a heavy door for the person a few paces behind, picking up an item someone (especially frail, old or pregnant) has dropped right in front of you or even smiling at a stranger who makes eye contact. It is about saying please and thank you to anyone helping you out even if it is their job to do it. It is about acknowledging your work colleague who does a little extra work so you don’t have to do it or staying longer at work to finish a task so they don’t have to hand it over to you. It is about realising your loved one is sad and giving them a hug. It is about saying the occasional thank you to your spouse for all the little considerations they give you daily that make your life better without you even realising they’re doing it.

I will say that I am lucky to be surrounded by lovely people who I am proud to call my family and friends. I know I did not get to choose my family but I certainly chose the family I keep close and the friends I surround myself with. These people are generous. They are donating to charity and taking part in fundraising for charities. They are courteous to strangers and helpful where they can be. They smile easily and are generous with their hugs, kind words and cups of tea. They recycle. They reclaim furniture. They treat their pets with love and tenderness. They are there when you get bad news. They hold your hand and sit beside you when there are no words that can ease the pain and hurt. They pray for you to succeed and celebrate whole-heartedly when you do succeed. They turn up when you need them the most. They laugh with you and not generally at you (but sometimes they laugh at you too if they know you can take it). They care about their neighbours and it is not always about them. They are diamonds…beautiful bling with surprising strength. They inspire me every day to be a better person and whenever I reflect on the people in my life, I feel blessed.