Mr. P, 80 years of age, a war veteran man was admitted with a chief complain of abdominal pain and loss of appetite. Looking at Mr. P for the first time gave me an impression that he was a good looking, gentleman back in his younger days. His looks was way younger that of an 80 year old guy. He was full of energy and enthusiasm during our initial nursing patient interaction. He enjoyed imparting every thing about him and he was so proud when he mentioned his family. He had six children who were already well-off and a great wife who would always make his eyes brimmed by just mentioning her name and losing her would be the most painful event that he could not imagine, more painful than the diagnostic procedures and treatments that awaited him.
Mr. P then had undergone several tests to diagnose what was bothering him. As days passed, we noticed that his abdomen was doubling its size and edema started to appear in his lower extremities. He had an ascites, one of the classic sign of fluid shifting. This was supported by the decreased value of albumin and globulin ratio revealed by his blood tests. Infusion of albumin was then initiated while seeking for the culprit causing the abnormality. Despite of the transfusion, Mr. P's condition did not improved and he began to express unrelieved pain and discomfort brought about by the fluid accumulating in his peritoneal cavity. Invasive paracentesis was performed and a Jackson Pratt was attached to his abdomen for continuous drainage.
The 15 minute monitoring and the routine draining of the JP allowed me to have a more in-depth conversation with Mr. P. This had also established a more intimate relationship with his entire family but I still didn't get the chance to meet Mrs. P and I was wondering why she was never around for her husband. The frequent small talks enable me to discover how Mr. and Mrs. P had end up with each other. Mr. P was a military man while Mrs. P was a pharmacist working in their camp. Mr. P would tell the story as if it just happened yesterday with his eyes sparkling. Seeing Mrs. P for the first time convicted Mr. P that she was the woman that he would spend his life with and the rest was history.
Unfortunately, it just took weeks when Mr. P started to deteriorate. His glowing face became a mirror of pain and anguish. His loss of appetite was never restored thus he became emaciated. Looking at his condition I could not help but wonder how certain malady can bring abrupt changes in one's body.
I was attending to another patient when Mr. P's doctor made his rounds having with him the rest of the results of the successive diagnostics. I was not around when he extrapolated his patient's prognosis thus I was shocked when I saw Mr. P's 2nd daughter bursting into tears along the hallway and upon seeing me, she wrapped her arms around me. I was not exactly sure if I had heard it right when she uttered "he has only 2 months to live." I was stunned, as if my brain stopped transmitting the info, I just could not absorb what she was trying to convey. I stood frozen and as the ice melted in the light of reality, I was able to hug her back tighter than she did. However, I remained speechless and the hug was all I could offer that time believing that action speaks louder than words though I really don't know the exact words that she would like to hear.
Liver CA. These words kept ringing into my ears. Mr. P had a liver CA despite of his unadulterated familial and social background. Even the attending physician could not lucidly explain how Mr. P acquired such detrimental illness. "Unknown cause" was the simplest answer. With this final diagnosis, I expected that Mrs. P would finally show up in able to comfort her ailing husband, but then she was not there as I hoped.
Later did I unraveled the reason why when she was also admitted with difficulty of breathing not because of asthma or pneumonia but because of the cancer cells that had reached her lungs originating from her breast. All along, she was undergoing chemo and her immunocompromised state pulled her away from Mr. P. Despite of her old age and the challenges that she have been through, her face still radiated as a gentle yet jolly woman who had perhaps reached the "Acceptance Phase" of grieving.
They shared a common room with three beds- the two beds especially positioned opposite each other but with distance in between giving space for others to pass through. The third bed was then placed at the middle corner for their children. Entering into room 306 gave me a sense of mixed emotion and expression. Witnessing their family battling to survive was compelling, the laughter that they made every time they reminiscence was contagious but the thought of expected death was poignant. Being in that room also made me believed that love until the end still exists. Each time that I take Mr. P's vital signs, Mr. P would always enquire how she's doing and he would always say, "you took good care of my darling first." He would always tell me to prioritize his wife in every way. Every day, Mrs. P would always find strength to get into her wheelchair in order to traverse the small space between them, for her to reach her suffering husband. As she reached the bed she will then take his hand and locked it with hers. They will say words that only both of them could hear and understand. Mr. P would in turn, brushed his wife's very thin white hair with his trembling hand. Every move they took and every word they spoke required so much effort but it didn't matter just to let each other know that they still have each other.
Feeling a little bit better, the family decided to take them home. The doctors agreed and I was somehow optimistic that Mr. P would make it more than 2 months but just weeks later after they were discharged; he was readmitted, this time because of unbearable pain and further loss of appetite. Mrs. P on the other hand was also brought to a more specialized hospital to deal with her multifactor onset of complications.
Mr. P looked worse than before and this time he refused to fully cooperate with the health team. He was so weak and fragile that every time I dressed his JP site and take his vital signs, the deep silence would envelope us. The presence of his children became his source of strength though I know that being with his wife would really revitalize him.
One time, I saw him talking on the phone and with the looks of it, he was speaking with his wife but this time no sparkle was in his eyes rather a pool of tears flooding his cheeks while saying these words "hold on darling." After hanging up he would then insists that he just wanted to be with Mrs. P which was not possible that time. One week after, Mrs. P passed away leaving Mr. P totally heartbroken. He was discharged after recuperating a little for him to attend his love's burial. I can't imagine the pain that Mr. P had endured but the impact of losing his wife was displayed when he once again brought back in the ER. He totally refused to eat, refused to interact and most of all refused to live. He was a replica of a soldier dropping his rifle in the middle of a war. With the absence of willingness to go on and with the progressive invasion of the cancer cells, the health team could not do much but to approach him in a palliative way.
Two moths and 3 weeks since I first met Mr. P, there I was reporting to the resident on duty that Mr. P was no longer responding to any form of stimulus, his O2 sat was below 85%, BP was 90/60. Oxygen was set to 10Lpm from 3Lpm, the nasal cannula was replaced by face mask to deliver sufficient oxygen. HGT revealed value way below normal and IV bolus of D5050 was ordered. I don't know how I was able to absorb every instruction that the doctors were giving despite of the fact that my emotion has reached its lowest point to the point that I almost drop my tears while administering the dextrose. Mr. P was about to reach the end of his rope, we all knew this. His children were all present that time, whispering loving words to their father, they then decided to sign the DNR which would mean no medications and treatment would be given in the event of a cardiac arrest. They have to let go and I knew it was never an easy decision to make. It was heart breaking; little did I know that my emotion was also because of the question that pop upped while I was taking care of Mr. P the whole time. "Will I also care and cry for my own father who had never been a father to me?"
My duty was almost over. I then looked at Mr. P for the last time remembering every detail of his face while silently praying. I tried to smile and then gently touched his arm and said goodbye. Walking down the stairs, his eldest daughter hugged me and with her sweetest smile said "thank you."
Having Mr. and Mrs. P as my patients is an indelible part of my profession. Through this couple, I have witnessed not just a moving love story but also love that overflowed from their children, friends and even relatives and most of all the unselfish and enduring love that our health team had offered and experienced. Nursing should be therefore not just an art and science but rather it should be more about love expressed through art and science. J
