I hear you

I heard all of this yesterday, but I doubt anyone will ever know because I am dying. They didn’t think I was listening, but listening is about all I can do. Perhaps one day there will be a way of reading these final thoughts, some scan, some process. I hope so, because they need to know.

I was reasonably alert when I came into hospital, but as the pneumonia progressed I grew more and more drowsy. When I lapsed into this coma – I suppose that’s how you describe it – they called a doctor to see me. I heard it all.

The nurse rushed away from me – her shoes squeaked into the distance – and called over to a colleague,

“Bed 9 looks awful, her saturations are 78 percent.”
“Put her on a non-rebreather…turn the oxygen right up…” answered the other.
“She’s scoring 9 though, should I put out a call?”
“Yes. No. Let’s take a look at her…”
I heard her feet settle at the end of my bed. She picked up my wrist and called out,
“Bleep the on-call, I think the saturations are under-reading because she’s shut down.”

Fifteen minutes later a doctor arrived.

“How is she?”
“Like we said. Drowsy, shut down. I would have put out an emergency call if I knew you were going to take this long…”
“Sorry, I had three others to see first.”

He was gentle, and spoke to me as he examined me. He summoned his senior because he was worried, and they talked to one another by the bed. It was strange – he must have thought I could hear if he talked to me during the examination, but if he thought I could hear why did he talk about me, in pretty impersonal terms, so close to the bed? The senior one spoke first,

“She’s going off. Type 2 respiratory failure. Is she for escalation or ward based care?”
“It doesn’t say she’s not in the notes.”
“OK, then we should take her to HDU.”
“For non-invasive?”
“Not right away, but for an arterial line, monitoring…”
“Can I do the line.”
“How many have you done?”
“She would be my fifth.”
“How did the other four go?”
“I missed one.”
“Ok, you can do it, she’s got a decent radial artery.”

He paused,
“I’m just thinking…if she should be for…”
“For what?”
“Everything. Let me just look at the x-ray and read the notes again. I mean, the ceiling will be non-invasive ventilation, ITU won’t take her…”
“She’s not that old.”
“It’s not that. It says here that her exercise tolerance is usually 30 yards,” (that’s true, my lungs have been awful for years due to smoking) “…and she was being assessed for home oxygen three months ago. She’s close to end stage. Let’s talk over here.”

They moved away. How very sensitive! They talked quietly at the nurse’s station, I think (I didn’t have the strength to open my eyes) – too quietly for me to hear – but I know they were deciding if I should ‘get everything’ or not. If I should be given a chance to live. Why move away now?

Then I realised what they were doing. They were trying to be decent, observing a social convention. I don’t think they were really taking my possible feelings into account, because if my feelings were really uppermost in their minds they wouldn’t have even started to have the conversation in front of me. I mean, what do I care how many bloody ‘lines’ that doctor has inserted? They forgot themselves, and it suddenly dawned on them that it was not the done thing to speak so frankly in the presence of a dying woman. They glanced at my face, probably, and wondered – oh God, what if she can hear? – and they became uncomfortable. I’ve seen and heard a lot of that here; behaviours that are explained not by the needs of the patients, but by the sensibilities of the doctors and nurses.

Anyway, I’m still here, same bed, same ward. Evidently it wasn’t felt to be in my interests to be carted along the corroder and attached to a machine. My family came in and spoke to me, then to the doctors, and they talked some more in a relatives’ room. They spoke for me. Quite right too. Later on I heard a nurse say they had ‘agreed not for resus.’ Fair enough. If these final moments of reflection come to a sudden stop I don’t want them running in and having a go at me. But I didn’t really need to hear all the explication, the justification, the gloomy prophecy bandied about with indifference. If you read this, medical people, be more careful with what you say in future. It takes very little energy to listen, and the words go in.

*

Comment I do not write this from a position of moral superiority. I have said many of those things, and worse, next to unconscious patients. It is expedient and, dare I say it, sometimes necessary to have clinically brutal conversations with colleagues in close proximity to obtunded, delirious, encephalopathic or comatose patients, especially in emergencies. But it’s worth reflecting that we have very little idea as to how much they can hear. Some will be just starting to deteriorate, and their faculties will be reasonably well preserved. Others will be truly insensible. The safest policy is strict separation from the bedside, but we are unlikely ever to adhere to that. So how does this fantasy help? If nothing else, it reminds us that behind every impassive exterior there is a mind, and that mind might, might, be as alert as yours.

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