Kevin Dueck, McMaster University
“After the feeding tube is placed and some training in using it you should be able to head home.”
I felt confident reassuring my patient and his wife about the plan the team had discussed. I saw his eyes beneath his baseball cap and with a nod he indicated understanding. His wife appeared content with the plan as well. The procedure was booked.
He had slowly lost weight and after visiting this family physician a number of times he eventually found his way to our ward. This was the first cachectic patient I had cared for during clerkship, at first I had trouble believing he could still walk. He had lost so much weight I couldn’t conduct a proper physical exam, his ribs so prominent there wasn’t a flat surface to rest my stethoscope to listen to his heart or lungs. He looked far older than his age, his cheek bones grimly protruding. We had done all the blood work, sent referrals and done a CT scan as well. No cause had come to light. It was felt providing nutrition was the priority and getting him home to avoid risks associated with hospitalization would be best.
The next morning while rounding I entered his room to find his wife in bed holding him. I tried my best to be discrete and addressed their concerns. I again expressed regret that we didn’t have and answer for his weight loss. She stayed with him all day in bed and was there again after the placement of the feeding tube. I was heartened by this, seeing their companionship and her comforting him during this difficult time.
The next day I was reviewing his chart and there was a new entry from a social worker about a meeting with the patient’s wife. As I read it I learned of her struggles to care for him at home during his deterioration along with her own health issues. The note also mentioned quoting the patients how disturbed she had been at a team member talking of the possibility of her husband's return home. My heart sank. My reassurance, rather than calming had induced distress. I hadn’t realized how poorly she was coping and the added stress his feeding tube would cause. We had ignored the needs of his caretaker in development of the plan, failing to appreciate her needs. The note ended with discussion of placement of her husband in a care home.
I rounded each morning hoping to see her and apologize. I checked multiple times a day to see if she was visiting. I never saw her again. It dawned on me that sharing his bed wasn't an act of compassion, but an extended goodbye.
I felt confident reassuring my patient and his wife about the plan the team had discussed. I saw his eyes beneath his baseball cap and with a nod he indicated understanding. His wife appeared content with the plan as well. The procedure was booked.
He had slowly lost weight and after visiting this family physician a number of times he eventually found his way to our ward. This was the first cachectic patient I had cared for during clerkship, at first I had trouble believing he could still walk. He had lost so much weight I couldn’t conduct a proper physical exam, his ribs so prominent there wasn’t a flat surface to rest my stethoscope to listen to his heart or lungs. He looked far older than his age, his cheek bones grimly protruding. We had done all the blood work, sent referrals and done a CT scan as well. No cause had come to light. It was felt providing nutrition was the priority and getting him home to avoid risks associated with hospitalization would be best.
The next morning while rounding I entered his room to find his wife in bed holding him. I tried my best to be discrete and addressed their concerns. I again expressed regret that we didn’t have and answer for his weight loss. She stayed with him all day in bed and was there again after the placement of the feeding tube. I was heartened by this, seeing their companionship and her comforting him during this difficult time.
The next day I was reviewing his chart and there was a new entry from a social worker about a meeting with the patient’s wife. As I read it I learned of her struggles to care for him at home during his deterioration along with her own health issues. The note also mentioned quoting the patients how disturbed she had been at a team member talking of the possibility of her husband's return home. My heart sank. My reassurance, rather than calming had induced distress. I hadn’t realized how poorly she was coping and the added stress his feeding tube would cause. We had ignored the needs of his caretaker in development of the plan, failing to appreciate her needs. The note ended with discussion of placement of her husband in a care home.
I rounded each morning hoping to see her and apologize. I checked multiple times a day to see if she was visiting. I never saw her again. It dawned on me that sharing his bed wasn't an act of compassion, but an extended goodbye.
