She was admitted with multiple medical problems.Failure to thrive was one of those.Eating food was just not her cup of tea.Always critical about food served to her.Sometimes complaining about taste,the way cooked,undercooked,overcooked,too sweet,too salty,no taste and the creative list goes on.The most amazing argument was when she started to say that "she is full".
Over time her sustenance was provided with tube feeding.Since nasogastric tube was cosmetically not favourable to her,she opted for per cutaneous gastrostomy tube.What a choice,we all wondered.The paradox was that she had no reason not to eat food in a normal way.
How someone get so focused on to not to enjoy life's one of simple oral pleasure is a topic for research.The answers can be varied with different reasoning but can it be as simple as declaring food is a medicine !
Tuesday, September 21, 2010
Monday, September 20, 2010
"may you keep healing"
She was admitted with a large abdominal wound open to external world with surgical stay sutures.She had others problems too,heart,lung,kidneys you name it. She was too complicated to be alive.
The one thing about her though was her amazing attitude.She was pleasant,hopeful,not too much concerned.She was dealing,rather living in her medical conditions,with an understanding.
During course of hospital stay,she got better and better.The failing organs were recovering and her wound was healing.Her wound nurse always saying to her,"may you keep healing"and to us,"treat whole patient not the hole".
How some people keep healing in the midst of difficult odd is fascinating.
To some it might be a matter of faith.To other a matter of luck.
I saw that as a prayer in action !
The one thing about her though was her amazing attitude.She was pleasant,hopeful,not too much concerned.She was dealing,rather living in her medical conditions,with an understanding.
During course of hospital stay,she got better and better.The failing organs were recovering and her wound was healing.Her wound nurse always saying to her,"may you keep healing"and to us,"treat whole patient not the hole".
How some people keep healing in the midst of difficult odd is fascinating.
To some it might be a matter of faith.To other a matter of luck.
I saw that as a prayer in action !
Sunday, September 19, 2010
"no home to go back"
He was a all rounder all his life.That was his claim.The medical conditions he was suffering made us belive in his claim.He was a hand full with daily issues.Almost all consult services were involved in his care.
His other talent was being a non stop talker.The stories of his accomplishments,how he lived his life with fun.All life experiences,free love,making money,trying stuffs and the stories after stories about this beautiful house of his dream where he had invested all of his passions.
He will never be able to return to his home with his condition.That was the reality,some say harsh reality of life.
How some one plan life but miss the part of thinking from the end.This is a history lesson.Most people live in a struggle to achieve.
To some Life is a Lie though fill in with Fun which ends up in a hospital or nursing home bed with no home to go back !
His other talent was being a non stop talker.The stories of his accomplishments,how he lived his life with fun.All life experiences,free love,making money,trying stuffs and the stories after stories about this beautiful house of his dream where he had invested all of his passions.
He will never be able to return to his home with his condition.That was the reality,some say harsh reality of life.
How some one plan life but miss the part of thinking from the end.This is a history lesson.Most people live in a struggle to achieve.
To some Life is a Lie though fill in with Fun which ends up in a hospital or nursing home bed with no home to go back !
Saturday, September 18, 2010
" I want to get married"
She was 20 and beautiful.She had a smiley face with short life expectancy.Everyone knew from beginning but no one want to believe.You have to see her to become an unbeliever.How she can die,the question with unmerciful answer.She was dying,rather fast with cystic fibrosis.
All our efforts were finally failing.I was assigned to discuss end of life with this patient. As I entered her room to tell her about her condition and our thoughts,she looked at me with teary eyes and said",I don't want to die".
The moment was stopped,life frezed.I was with tears in my eyes.I agreed with her that this is not the time to die",but we all will die at some point in time". She agreed and with a smile she said,"I want to get married".
Over next 12 hours she was married to love of her life.
How death takes away a life,it does seem so cruel when we see a random happening.To some it is a path of life, like a passage from here to there.
All our efforts were finally failing.I was assigned to discuss end of life with this patient. As I entered her room to tell her about her condition and our thoughts,she looked at me with teary eyes and said",I don't want to die".
The moment was stopped,life frezed.I was with tears in my eyes.I agreed with her that this is not the time to die",but we all will die at some point in time". She agreed and with a smile she said,"I want to get married".
Over next 12 hours she was married to love of her life.
How death takes away a life,it does seem so cruel when we see a random happening.To some it is a path of life, like a passage from here to there.
Friday, September 17, 2010
"gourmet ice chips"
He was admitted confused and remained confused over most of his hospital course. What he had done no one knew. His lungs were failing so was his brain.
One day he was driving a truck, the other day he was laying on beach. He was giving instructions to nurses and getting agitated with questions. Almost all of the time he had no idea about what was going on or what he was talking about.In reality he was laying in hospital bed.
The other day he asked us to eat and drink, When asked what would he like to eat or drink, his answer was, ”gourmet ice chips”.
When someone is confuse and still vocal then realities of every day conscious inhibitions come out in open.This takes us to observe interesting aspects of our mind. To some this altered state of mind is nothing but another experience of mind over matter.
To be honest our mind is totally dependent upon matter, call it gray mater or white mater.No mater,no mind. This is it !
One day he was driving a truck, the other day he was laying on beach. He was giving instructions to nurses and getting agitated with questions. Almost all of the time he had no idea about what was going on or what he was talking about.In reality he was laying in hospital bed.
The other day he asked us to eat and drink, When asked what would he like to eat or drink, his answer was, ”gourmet ice chips”.
When someone is confuse and still vocal then realities of every day conscious inhibitions come out in open.This takes us to observe interesting aspects of our mind. To some this altered state of mind is nothing but another experience of mind over matter.
To be honest our mind is totally dependent upon matter, call it gray mater or white mater.No mater,no mind. This is it !
"can I have one cigarette"
She always appeared short of breath,I wondered what was going on with her.I did diagnostic tests one after another.All those tests were pointing to one diagnosis that she might have progression of her prior diagnosis of tracheomalacia.Now bronchomalacia was also added to insult and she was short of breath all the time.Luckily her oxygen saturations were decent while awake,with activity and during sleep.She had a fighting chance.
Every day during medical rounds,she showed her frustration to keep staying in hospital.Every day I explained to her the reason behind keeping her in hospital.
One day she told me that she would like to be discharged in next two days as she had to attend this party.I did not asked the details but it did not worked out as she remained hospitalised due to her shortness of breath.
Finally after few more days of care and a definitive management plan,I was able to talk about a hospital discharge day.
The day of discharge,she asked me one question,"can I have one cigarette a day".I looked at her with a smile,rather in pity,and said,"No".
Why some people knowingly do what is not good for them.I wonder,isn't this just human.
To some their need to ask the question,like she did,is not a simple curiosity.The real question is to ask ourselves,was it just a simple need to tell what her desire was or it was more so a self defence with a powerful validation from her doctor allowing her to smoke one cigarette a day.
I felt for her but I did not fall for her !
Every day during medical rounds,she showed her frustration to keep staying in hospital.Every day I explained to her the reason behind keeping her in hospital.
One day she told me that she would like to be discharged in next two days as she had to attend this party.I did not asked the details but it did not worked out as she remained hospitalised due to her shortness of breath.
Finally after few more days of care and a definitive management plan,I was able to talk about a hospital discharge day.
The day of discharge,she asked me one question,"can I have one cigarette a day".I looked at her with a smile,rather in pity,and said,"No".
Why some people knowingly do what is not good for them.I wonder,isn't this just human.
To some their need to ask the question,like she did,is not a simple curiosity.The real question is to ask ourselves,was it just a simple need to tell what her desire was or it was more so a self defence with a powerful validation from her doctor allowing her to smoke one cigarette a day.
I felt for her but I did not fall for her !
Thursday, September 16, 2010
"paper cuts"
She was visiting to see a patient.There was something different about her which caught my attention.She was wearing a long flowery dress,and rather awkwardly dark make up and lipstick.She was a pretty girl at some point. In a moment all those thoughts of why,how,may be,definitely came to my mind.Those were thoughts of judgement,when we judge other people and label them.As we say that was the defining moment when we mentally undress other person for one reason or other.
I thought she don't have to show off this much.She walked by me,I kept my thoughts to myself,but I had noticed that her feet were rather swollen and she had a generalised rash.The thoughts which were there a few moments ago transformed into rather a new perspective.She was not what she looked a few moments ago.She was trying to hide disease of her skin,a condition, which I knew,felt like paper cuts.
I understood then something about life.All that dress up and all that make up was the struggle to hide all,hoping to change her skin like a dress.
I wondered then,as I wonder now.How the concept of inner beauty remains so cursory in our world of impressions.Beauty certainly is an interesting contradiction.
I felt for her and I kept her secret.
I thought she don't have to show off this much.She walked by me,I kept my thoughts to myself,but I had noticed that her feet were rather swollen and she had a generalised rash.The thoughts which were there a few moments ago transformed into rather a new perspective.She was not what she looked a few moments ago.She was trying to hide disease of her skin,a condition, which I knew,felt like paper cuts.
I understood then something about life.All that dress up and all that make up was the struggle to hide all,hoping to change her skin like a dress.
I wondered then,as I wonder now.How the concept of inner beauty remains so cursory in our world of impressions.Beauty certainly is an interesting contradiction.
I felt for her and I kept her secret.
Wednesday, September 15, 2010
"losing voice to eat"
He was a patient with a problem with his larynx and he was admitted with a tracheotomy tube.He was getting his nutrition through a nasogastric tube.
I learned quickly during my first interaction with his wife that she was a solid advocate for her husband.As I knew them overtime,though much of a surprise,they were a perfect couple;passive-aggressive-manipulative in the broader scheme of events.
During my daily patients round,I was made aware that they were in the process of making a decision to have his larynx removed surgically so that he can eat.
In essence he was willing to lose his voice box in order to eat and get rid of a feeding tube in his nose.It was known to all that eating,not talking, was his top priority.
How one can negotiate ones own compromise is mind boggling.How some people do it with such a clear mind is so unclear to most of us.They give up one vital function to keep another.This is probably one of the most difficult compromise one has ever to make.The choice made here was the one that he has to live with,a choice of no voice forever,and who knows what will be in store for him in meals !
I learned quickly during my first interaction with his wife that she was a solid advocate for her husband.As I knew them overtime,though much of a surprise,they were a perfect couple;passive-aggressive-manipulative in the broader scheme of events.
During my daily patients round,I was made aware that they were in the process of making a decision to have his larynx removed surgically so that he can eat.
In essence he was willing to lose his voice box in order to eat and get rid of a feeding tube in his nose.It was known to all that eating,not talking, was his top priority.
How one can negotiate ones own compromise is mind boggling.How some people do it with such a clear mind is so unclear to most of us.They give up one vital function to keep another.This is probably one of the most difficult compromise one has ever to make.The choice made here was the one that he has to live with,a choice of no voice forever,and who knows what will be in store for him in meals !
Tuesday, September 14, 2010
"losing more than one can"
One day I saw this man smoking outside the designated smoking area on hospital grounds.I was very frustrated as he was smoking in other peoples routine walkway.As I approached closer to him from the parking lot,I recognised him as a hospital patient.He was sitting on a wheel chair and he had no hands and no legs.He had amputations for reasons of poor circulation and he was rehabilitating.
The most interesting aspect was that a woman was helping him to smoke,putting cigarrete to his lips,he was inhaling then she was removing cigarrett from his lips and then he was exhaling smoke from his mouth and nose like a chimmney. What a shocker?
I could not take it,so I went to him and without any reservation I said,"sir this is not good".
He looked at me with a piercing gaze and replied,"what he will going to lose".
How some arguments can reach a dead end is amazingly not so simple.The only thing what made him to say what he said was his total disregard to life,his and others.
He made a selfish argument about himself with total disregard to others. His woman companion who was helping him to smoke and peoples using walkway where he was smoking.He was exposing them with his second handed smoke in the truest sence of words.
To some he may be losing more than he will ever know.Perhaps more than losing his limbs,he was losing respect !
The most interesting aspect was that a woman was helping him to smoke,putting cigarrete to his lips,he was inhaling then she was removing cigarrett from his lips and then he was exhaling smoke from his mouth and nose like a chimmney. What a shocker?
I could not take it,so I went to him and without any reservation I said,"sir this is not good".
He looked at me with a piercing gaze and replied,"what he will going to lose".
How some arguments can reach a dead end is amazingly not so simple.The only thing what made him to say what he said was his total disregard to life,his and others.
He made a selfish argument about himself with total disregard to others. His woman companion who was helping him to smoke and peoples using walkway where he was smoking.He was exposing them with his second handed smoke in the truest sence of words.
To some he may be losing more than he will ever know.Perhaps more than losing his limbs,he was losing respect !
Monday, September 13, 2010
"already accepted that he had died"
She walked in with her portable oxygen tank,upset about not knowing that her husband,who was a patient, went on an appointment at a tertiary care hospital without her knowledge .I explained to her about her husband's serious condition and that the scheduled appointment was a follow up.
I did my part by explaining things in a way to comfort her.She did calmed down.Then she told me that "she had already accepted that he had died before his admission to this hospital".She continued and said,"now what ever is there is OK with her,at least he is alive".
In matter of days and weeks,the patient got better and better.
He was more alert,breathing better,talking with periods of agitation and confusion.Bottom line he was living again and not dead.
One day she asked me,"why her husband is not getting better".I looked at her and reminded her where we started in the beginning.
I wondered then,and I wonder now.How people develop expectations and lose complete perspective.This is an interesting observation which we face daily.
Yes,we can fix curable,but dying with aging and diseased organs is certainly an under reported and virtually unsaid reality.
The biggest challenge is how to convey this to all of us without getting into a confrontation.
I did my part by explaining things in a way to comfort her.She did calmed down.Then she told me that "she had already accepted that he had died before his admission to this hospital".She continued and said,"now what ever is there is OK with her,at least he is alive".
In matter of days and weeks,the patient got better and better.
He was more alert,breathing better,talking with periods of agitation and confusion.Bottom line he was living again and not dead.
One day she asked me,"why her husband is not getting better".I looked at her and reminded her where we started in the beginning.
I wondered then,and I wonder now.How people develop expectations and lose complete perspective.This is an interesting observation which we face daily.
Yes,we can fix curable,but dying with aging and diseased organs is certainly an under reported and virtually unsaid reality.
The biggest challenge is how to convey this to all of us without getting into a confrontation.
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