Case history

Juan was fifteen months old when his sister was born. His family lived in a village in Peru. His father was a farm worker who earned very little money. His mother wanted Juan to be healthy, and she saw advertisements for vitamin pills in the shops. She bought two bottles of pills every month, which cost a week’s wages. She could not afford to buy meat and vegetables as well, so the family ate only rice. She became anemic, and did not have enough breast milk to feed his sister properly. The baby was small and weak, and Juan was also weak because of lack of good food. Juan’s mother did not understand about immunization, so she refused to take the children to the clinic. When Juan developed measles, he was not strong enough to fight the germ. He died of a disease which was both preventable and treatable. The vitamin pills were a tragic mistake.

The intensive care doctor

Most hospitals today have an intensive care unit. The doctors and nurses in this unit look after patients who are extremely sick. Many of these patients have had serious road accidents. Some are victims of violence. A few have severe infections or other illnesses. Others are recovering from major operations such as open heart surgery. Patients on the intensive care unit have difficulty performing the most basic functions of life: breathing, maintaining the circulation of the blood, and eating. No single drug can restore all these functions, and no machine can permanently replace them. But modern drugs and machines can help temporarily while the patient’s body is healing.

Case history

John was a fifty-four year-old truck driver. His wife sometimes traveled with him. One day, they had a serious road accident. John was knocked unconscious; he broke several ribs and he also broke his leg badly; in addition, his abdomen was crushed and his kidneys were damaged. He was trapped in the truck for five hours until the rescue team cut him free. The ambulance took him to a hospital, where he went straight to the intensive care unit. The doctors connected him to a ventilator, and also to a hemodialysis machine because his kidneys were not working. They gave him a large blood transfusion and performed an operation in his leg.

John was unconscious for two weeks but he recovered without any brain damage. The doctors switched off the ventilator, and John began to breathe for himself. His kidneys also recovered so he did not need hemodialysis for very long. The nurses and physiotherapists worked hard to prevent pressure sores and stiff muscles. John did not remember the accident, and he did not know that his wife had been killed. The doctors waited until he was stronger before they told him the bad news. John became depressed. The nurses tried to cheer him up and motivate him to start a new life. He was on the intensive care unit for three months. Eventually, he recovered completely but he will never lose the psychological scars of that fatal accident.

The terminal care doctor

Much progress has been made in medicine over the past 100 years. No doubt even greater progress will be made over the next 100 years. But some diseases are still incurable, and many of them will always be incurable. The only certainty in life is that we will all die eventually. Terminal care is the branch of medicine which deals with incurable diseases. Doctors cannot prevent death, but they can help patients to spend the last months of their lives comfortably and to die with dignity.

Perhaps the most common cause of loss of dignity is poor communication. The doctor is afraid to tell the patient that he is dying, and the patient’s relatives want to protect him from bad news. When the patient asks if he is getting better, everyone lies to him. This behavior is insulting to the intelligent patient. If you were dying, would you want to know? In the United States, terminally ill patients have sued their doctors for withholding the truth about their illness. The patient is not a child or a fool. Breaking bad news is a painful experience for the doctor and the patient’s relatives, but they all have a duty to be honest. Many people are surprised to find that patients who know they are dying are less frightened about death than patients who have been told they are getting better.

Terminal care is unique branch of medicine because the doctor is not trying to cure the patient. The doctor’s aim is help the patient spend the last few months of his life in comfort and dignity, to help him to prepare for death, to give care and compassion when he dying, and to offer emotional support to the bereaved relatives after the death.