Chicken soup for the soul, anyone?

Today is the day for palliative care site visit. It's quite an interesting one, and 'fruitful' too =P

Palliative care is not ALL about death and dying. The purpose of palliative care is to keep the patient comfortable (i.e. as pain-free as possible) and improve their quality of life despite having a terminal illness. I followed a palliative care nurse to do 4 home visits this morning. Before the first visit she briefed me about the patient's condition: 85-year-old Hungarian lady who can speak a fair bit of English, staying alone, diagnosed with endometrial cancer but declined treatment, husband and son passed away few years ago, very independent and loves baking. 'Dexamethasone is what gives her appetite, and she is able to get up and do things she wants, that really improves her quality of life. But the thing is dexa can give you muscle weakness, especially of the legs. So she currently has a bit of weakness in her leg now...[etc etc.] She's very cute, does things very well at her age...I'm very proud of her,' the nurse told me. She organised an interpreter to come along as well.

At about 10am we reached the place. On reaching her doorstep we were greeted by this elderly lady who welcomed us warmly into her house. It is very neat and tidy, there are many framed photos and pictures hanging on the wall, and she has 2 wooden cupboards full of glass decorative items and statues of humans and animals...can compare with my mum's dy =P I was very much amazed of how she managed this well. An 85-year-old lady with weakness in her legs managing all this on her own!! We sat down and I noticed that she has severe peripheral oedema (which I found out later that it's recent onset). Anyway, our conversation started...

Lady: I have to attend to my stove, I'm cooking chicken soup...

[She walked in and out of the kitchen and living room, finally struggled to sit down due to her back pain]

Nurse: So how have you been doing?

Lady [with interpreter]: I'm all right, just my back hurts since 2 days ago, and yesterday it was so terrible that I couldn't get out of bed. [Someone] came and knocked on the door yesterday and I couldn't get up to open the door for him.

Nurse: Can you describe the pain for me?

Lady: Very bad. It goes to both of my legs, and I have pins and needles...

[She got up with much difficulty and went back to her stove again]

I noticed that she walks with difficulty due to both the peripheral oedema and lower back pain. So just picture the old lady with one hand holding her back and walking with difficulty in your head...

She came back a while later and discussed about her medications with the nurse. The nurse made a phone call to the doctor to describe the situation and decide the next step....I'm not going to write the probability diagnosis here, you guys can figure it out~ When she came back into the living room she had 3 plastic bags of fresh ripe figs with her, 1 bag for each of us (yes including me!! Imagine how surprised I was!!)

After the nurse put down the phone she spoke to the old lady again.

Nurse: Look, I'm worried about your back pain, I think it's something to do with your spine, we need to get you to the hospital so they can do an MRI scan to see what's going on....it's like a complicated X-ray....

Pause.

Lady: Now??

Nurse: Yes now.

Another pause.

Lady: But I'm cooking a big pot of chicken soup!!!!

Nurse: I KNEW you would say that!! [laughs] I'll arrange an ambulance to come and take you to the hospital. Can you try and pack the chicken soup (put in separate tupperwares) and put it into the freezer? How long do you think that's going to take you?

Lady: The chicken soup needs another hour to cook, then I have to let it cool down...so maybe a few hours?

Nurse: Hahaha! Alright. I'll arrange the ambulance to come at 4 o'clock. Okay darlin'?

And she went on to emphasise how important and necessary it is for her to go to the hospital and reassure her that she (the lady) would come back to her house, not '一去不回', which is the reason the lady was quite unwilling to go to the hospital at first. And also talked to her about things to bring and what would happen when she's at the hospital. Then she dialled 000 (because she didn't have the non-urgent emergency number with her)....explained the situation and said she wanted a non-urgent ambulance to come at 4pm (and got told off by the person at the other end of the call) until she said:

'Let me tell you why. This is an 85-year-old lady, and she is NOW cooking a BIG POT of CHICKEN SOUP!!!'

The nurse later told me that the lady whom she talked to to call an ambulance said, 'The boys [from the ambulance] can bring her in alright...Is it possible for her to bring some of the chicken soup to the hospital?? Now you are making me thinking of chicken soup the whole day!'


Now that's an interesting one, isn't it?

Fresh ripe figs from the lady...I'm not sure how you 'deal with' figs, will find out later~

Message from the nurse during our journey: Don't ever ever destroy their hopes. Hope is what keeps them going, it keeps them alive. And this is not only about the hopes of patients actually, it applies to everyone as well. You don't have the right to destroy other people's hopes, do you?