Changing faith...
This 75 year old lady was brought
into our hospital a month back with distension of abdomen. Distension usually being
of surgical cause, she ended up in the surgical ward. The next day, our senior
surgeon recognized that she had a Renal problem and asked some of us to review.
We saw that the lady had a chronic kidney failure with a creatinine of 2.9 –
indicating that she has lost almost 60 to 75% of her renal function. An US
examination confirmed our doubt. Being of elderly age, and not having options
for renal replacement therapy – (Dialysis or Transplant) we did the best we
could. We gave her drugs to control her blood pressure, electrolyte abnormalities
and prepared the family for a palliative care at home. But the family was very insistent.
Somehow she has to be made well, and they wanted to take her to a higher center.
Being insistent, and having little trust in our “Diagnosis” and advice, the
best we could do was to give them a referral letter.
We did not hear from them for a
month. A month later, she was brought back, in a worse state. She was in fluid
overload, creatinine had gone up from 2.9 to 8.6, indicating that she had gone fast
into end stage renal failure – almost 99% of functions lost. We were surprised
at this fast deterioration. Slowly stories emerged. Instead of going to a
Medical college, she had gone to a private nursing home in the capital city.
Where she had an ultrasound which showed damaged kidneys, but blood tests which
showed normal renal function! This seemed to be from an attached referral laboratory
of the hospital! Based on this she was given drugs, which were harmful to the
already damaged kidneys and she worsened fast. She insisted that she be brought
back to our center, since she had started feeling better initially with us.
Now she has been with us for 10
days. She is in end stage renal failure, slowly deteriorating in front of our eyes.
Despite talking to all the members of the family one to one, they do not want
to take her home but want to keep her till she becomes better, which for us
medically is not possible. Last two days on rounds the story slowly emerged.
The family was advised to go to a
private nursing home by some local “agents” and they went there and spend quite
a bit of their limited resources. The experience has left them, with some
changed perspectives. They were told, that she will be fine, but in our center
we had told she will not get better. The faith in the system which promised
cure (that was what they wanted to hear, and it was offered to them) has
changed to lack of faith, and lack of faith in the system which told that there
is no cure, (which was not what they wanted to accept) is slowly changing to
faith.
But the reason they brought the
mother back and is still keeping her with us despite we asking them to take her
home was revealed by the old mother herself to the nurses. She told, I will not
go home, my children will not take care of me, I want to be here and be cared
for. She has lost her faith in family and putting all her faith in a health
care system which can offer no cure, but has the potential to provide care and healing.
And the children are finding in tough to disobey the adamant mother! She wants
us to be her family…
In such a low trust context, how
does one continue to provide trust worthy care? How does one care when people
do not trust your open and transparent opinion? How does one care when there is
no cure, but all want only cure and that too yesterday, not tomorrow!
Can health care become the alternative
care providers, replacing family? Patients desire vs families desire, which
should we keep upfront? In such a resource limited setting, how does compassionate,
cost effective, evidence based care look like?
WWJD – if he was the treating physician?
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