Some patients I never forget

September 30, 2012

As a medical student one has little actual responsibility for the care of the patients one sees as obviously qualified doctors are overseeing everything. We are superfluous to requirements and there to learn rather than contribute. On the whole most patients were generous enough to let me study them. In fact, I don’t remember anyone ever refusing. Perhaps they were worried the doctors wouldn’t treat them as well if they did. I hope not. It isn’t the case.

My favourite firm as a medical student was Oncology. The cancer ward. I had already done Cardiology and Metabolic Unit, and hated the latter. It was run by two dry Consultants; one an academic expert in these rare diseases we were seeing and the other old and boring. The juniors called him ‘Shifting Dullness’  – a medical term relating to fluid in the abdomen but one which perfectly described his ward rounds.

Oncology on the other hand was brilliant. The consultant was fantastic. Inspiring. And the patients were incredible. Two I remember in particular. One of our jobs as students attached to oncology was that we had to administer all the intravenous chemotherapy . Nowadays one gets gloved up and puts safety googles on to handle these toxic chemicals, but we were just sent off to the treatment room to try to work out what to do by ourselves. Some of these medicines would cost hundreds of pounds  a vial. Even then.  Nobody taught us how to draw up intravenous drugs so we didn’t realise they were vacuum packed. What that means in practical terms is that if you stick your syringe in to the bottle to try to draw up the liquid you can’t pull the plunger back as the vacuum is fighting against you. What you have to do is inject air in to the bottle to break the vacuum and then withdraw the same amount of drug as you have just injected in air. If you don’t do this correctly the whole thing can explode and spray toxic chemicals all over the room. Yes, guess who managed to do that….
So we would spend quite a bit of time on the wards with the patients and get to know them well. And of course in the oncology ward, many of them had life-threatening diseases.

The first patient to make a fundamental impression on me was a man in his 80s. I can’t tell you his name although I’d like to so that he would get the recognition he deserves. But confidentiality extends post mortem so I can’t. I can see him now. Sitting up in his bed, leaning forward trying to catch his breath. He had lung cancer and at that time there were no successful treatments for the type he had. I was assigned him and had to take his history and examine him.

He had various scars and so I had to ask him what they were from. It turns out he had fought in the First World War. He was in the battle of the Somme. He watched thousands of men be killed or mortally wounded. He was in the medical corps. He was stationed at a kind of triage post where the casualties would come or be brought and he would decide whether to send them on to get proper treatment, giving them basic first aid as needed or if there was no point sending them on, then just making them comfortable. He had administered to thousands of young men and they still haunted him. He had tears in his eyes as he talked about the horrors of war.

The more he told me the about the awful the things he had witnessed, I was amazed he had managed to come out of it, get married, have a family and a normal life. The huge burden of trauma he was still processing sixty years later was humbling. He had never talked about it to anyone, not even his wife, but now he was dying and I had started asking questions, he wanted to let people know how awful it had been. I wish I’d known more history to be able to ask more pertinent questions, but it seemed he would just talk about it without much prompting.

I only saw him a couple of times as he died within days of our starting on the ward. Much more quickly than I had anticipated. I was surprised how sad I felt, as if he were a close relative or friend. He had reminded me of something that I already knew but the arrogance of my youth had decided to forget; these ‘old people’ I was seeing were much more than simply a sum of their current symptoms and signs. They were living history and had experiences and feeling that could not be guessed at by looking at their frail frames.

The other patient from that firm (as we called our time on a given unit) who stays in my head was a 26 year old with leukemia. She was amazing. Life affirming. Positive. Wasn’t taking this lying down. Shaved her head and sometimes dyed it bright punkish colours. Had to undergo horrendous chemotherapy which I would administer in to her bloodstream and she would feel atrocious for days. She was an inpatient for a long time and as she had no working immune system one had to get gowned up to go in to her side ward to try to minimise the risk of her getting an infection. So she didn’t have lots of people popping in to see her. But she was always great. I loved going to see her as it was like seeing a mate. We would chat about all sorts; men mostly. She was always smiling and laughing but she knew she was very ill. She wasn’t in denial, but coping incredibly well. Except very occasionally she would let the mask slip. I was probably too inexperienced to be any help to her, whereas she was able to help me understand the feelings she was wrestling with. And there would be tears.

After I finished the oncology rotation I still popped up to the wards to see if she was around and have a chat. Sometimes she would be well enough to go home, which was great for her, but I would be disappointed not to be able to chat to her. She died about eighteen months later. I hadn’t known she’d been admitted and had been on a rotation up in Bedfordshire so hadn’t been in for a couple of months. I was gutted. I felt guilty I hadn’t seen her during her final days and weeks. She had been a similar age to me, a fighter, had the best possible care and yet she had been taken. It was so bloody unfair.

I realised it was nothing more than luck that I was on this earth and she was not.


5 Responses to “Some patients I never forget”

  1. […] before I was left to do it myself. I had really enjoyed my stint on the Oncology ward as I blogged here, and had seen an inspirational Consultant talk to his patients about death and dying. The best […]

  2. Anonymous Says:

    I love that these people live on through you. I can completelys relate to your experience with Mr. WWI – I have my own beloved Mr. WWII, who never shot anyone but is tormented by his memories. Thanks!

  3. georgiemcclarke Says:

    So tragic and so unfair. Great post though, very touching x

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