Saturday, November 25, 2006

The Good Wife

Say what you will about Ginny, our chaplain: for being a Godly woman, she has the worst sense of timing in the world.

It had been an officially long day. From the time the 20-year-old started seizing to the point at which I finished holding pressure on an arterial puncture site that had broken open, it was the sort of shift you don't want to work, let alone be charge for. And there I was, charging.

I had wandered into the break room in search of something to eat--it was about six o'clock, just before the end of shift--and Ginny came in after me.

" know that guy with the huge glioma? The young guy?" She gave me a few other details so I would remember exactly *which* young guy she was talking about. He was a typical glioblastoma patient: loving family, good job, healthy up to the point that he developed personality changes and seizures. Eight months before, we'd taken out as much of the tumor as we could manage and sent him off for experimental chemo.

He'd come back last month after failing treatment. (I love how we medical types say that: "The patient failed treatment." Not "the treatment failed the patient," which is how it actually works. No, the patient fails. Our treatment *never* fails, right? It's those damned patients who screw up.) We'd pumped him full of steroids, told his family that his brain was now officially mostly tumor, and recommended hospice.

Which his lovely young wife had agreed to. It was, after all, the best decision: stop cutting the poor man open, quit exposing him to nasty chemotherapy, and let him enjoy his kids while he could. He'd been at home for three weeks, doing about as well as you could expect--in other words, dying pretty peacefully. His wife had taken him home, despite the care he'd need, because she didn't want him to be alone. They'd barely been separated in fifteen years of marriage; she didn't want to start now.

"So," Ginny continued, "His wife dropped the kids off a couple of days ago with their grandmother, got into the car, drove out to the lake, and took a couple handsful of pills and drank a half a bottle of vodka before she passed out."

"She didn't" I replied. "Yeah, she sure did," came the response.

At which point I surprised everyone, myself most of all, by turning around and bursting into tears.

I guess it shouldn't have been such a shock. That I burst into tears, I mean. When you see enough people die, you start to grieve unexpectedly over peripherals--the dog they've left behind, who wonders where its human went off to, the kids who take the news that Mommy isn't going to be around anymore stoically, without really understanding. You can't grieve over every patient you lose, because if you did, your soul would be shredded into little bitty bits.

So you get into peripherals. The news that yet another person you cared for has ended up in the City section, under Obituaries, is met with a "Damn shame, that. Nice guy" and you go on.

What makes a person so indispensible to another person that their death would trigger an attempt at suicide? Is it grief that drives people to down Xanax and Valium and Skyy, or is it fear? Why do the weirdest, least-well-adjusted (at least on the outside) people manage to continue living after somebody dies, and the best-adjusted people with the best support systems just give up?

Those questions end up filed under the same heading as "Why do glioblastomas hit nice people?" and "How come mean people live forever?" There's a folder somewhere labelled "Damned if I Know".

So there's the peripheral for the week, or month, or season. The good wife, the one who didn't want her husband to be alone.


Anonymous said...

You comment about people with "good support systems" got me thinking. I think that people with "good support systems" come to depend on them. If something happens to change or upset that system the person can become very frightened or fearful. They succome to fear and give up.

Those of us (myself as an example) who are "weird or less well adjusted" for some reason do not tend to develop a "good support system" because of our poor adjsutment. This means that we have to learn to find our own resoruces to survive. If something happens we "weird or less well adjusted" folks tend to have the inner resources to survive.

Our survival is not allways pleasant or graceful, but somehow we do survive.

overactive-imagination said...

That's so sad. One of my biggest concerns after graduation is how well I am going to cope with being surrounded by death and dying. I think that's why alot of new nursing grads want to go into mother/baby in hopes of seeing less death and more joyful moments.
I guess we'll have to wait to find out.

shrimplate said...

Dawn- dead babies are no fun either.

Watch 'n Wait said...

Could you give your opinion on the CyberKnife? I'd sure appreciate it.

Jo said...

W&W, we use Accuray and CyberKnife at the hospital, but on an outpatient basis. The patients I've had that have had AR/CK treatment have all been glioblastoma patients, so they've all died anyhow.

That said, I've had a couple of patients who've done reasonably well after treatment. It's certainly a boon for those folks who have tumors we simply can't get to without major damage to surrounding brain structures.

One exception: a guy I remember was young--no more than about 19--and had metastatic cancer from *somewhere* (we never were able to determine where, maybe breast) that was very successfully treated with a combination of CK and chemo.

You'd do better to check the stats on Google. My experience is too limited, and my patients of too limited a group, to really give you good information.

Watch 'n Wait said...

Thanks very much. I'll look at Google as you suggested.

Anonymous said...

We all get those patient's we remember or rather maybe the family we remember. I had a patient 5 years ago, dying un-neccesarily because she choose to hang onto a leg that was making her septic. Multiple co-morbidities...including weighing 500 lb...really...Finally entubated, and obtunded with floor-length hair..her crowning helpless tangles. I, a new grad, to my Charge's horror, spent two hours and a whole bottle of Johnson's no-more tears/no more tangles combing out and braiding the mess. The husband cried,he was so appreciative, I got in trouble for not using my time wisely. The week after she died he came back to the hospital and wanted to kill everybody there for not keeping her alive...then a week later he was back as a suicide attempt.