sighhhh.....when tears are shed, at least they evaporate and water the world again...

When an everyday occurrence in your line of work, includes making people cry...after a while you can't help but feel like a jerk. In my line of work, I see tears just about every other day. In my patients, in relatives....these people are grandfathers and grandmothers, kids and grandkids, neighbors and friends. I knew it was coming, we were 'taught' how to handle these situations in school. At first I used to try really hard not to shed tears myself. I always thought I had to look strong and be supportive and sympathetic. And I have to say I have done well. I have probably welled up inside a handful of times, but only ever let the rivers of Jordan flow once.


I don’t think that is anything to be proud of or sing as some sort of victory, but its one of those things you've got to do. If I cried every time I saw someone struggle (like I do on the inside cos I am a big sook!) and they saw me cry, perhaps they would think that 'I' thought their prognosis was bad and then give up. Its one of those things where you know someone is suffering, but you have to be strong, so that they remain strong and positive, and remain warriors. Studies have shown that patients who are positive and go in fighting- always tend to have better outcomes then their counterparts who remain feeling hopeless and seemingly give up- for whatever bizarre reason -when a very ill person says in their head, this is it.. I give up, more often then not, they tend to fade away pretty soon after. So we try not to give people the impression that all is lost, even when we know...that their chances are dim.


Today I watched on with 6 other people (daily gaggle of ward round people, 3 docs, nurse, physio, social worker...etc) as a 75 year old man cried. He cried because he was a victim of his own body failing him. He has pretty advanced Parkinson’s and Dementia...and slowly he loses not only the function of his body, but his sanity. At present his mind flickers in and out of sense, but you can tell by looking in his eyes that he fights it with every single muscle in his body. He can answer simple yes/no questions appropriately, but once he starts to speak in sentences his mind soon wanders and before you know it, he is making no sense at all.

The heartbreaking thing is you can tell, he knows it. Throughout his 'mumbo jumbo' talk he will say things like "my mind is all nonsense" and things like "who would want me anyways, my wife should divorce me" (wife is sole carer- no kids, and does everything to prevent him from going into a rest home). When we try to tell him that the reason he is in hospital( because he forgets) is that his health, including his Parkinson’s is getting worse, he will look up at us, then look down at his feet and cuts us off and says " I would rather not know, thank you"...

Yesterday he became unwell with tummy pain, and we discovered he had difficulty going to the toilet and his bladder was extremely distended. He needed a catheter. When I went to tell him he was floridly confused, counting 1- 20 repeatedly and making no sense at all. But the moment I mentioned catheter he stopped, looked at me and said hurriedly “I have the right to refuse! I have the right to refuse!" through all his mumbo-jumbo he still tried his hardest to keep his dignity, despite knowing he was in pain and needed intervention. Eventually he agreed, but not before breaking down and crying in front of me. I felt like a jerk, making a grown man cry. Not just a grown man but a man who had experienced this world 3 times my lifespan including WW2. I felt so insignificant next to this man, and felt like a jerk for stripping him of his last few bits of dignity.

Today we also had a 30 yr old woman cry, she had developed this weird lump around her neck mysteriously over the last few weeks. She has had numerous scans and test done and so far no one can really tell her what it is, so we are having to send her on to another specialist centre. All day she has been sat on the ward, and everytime you go to chat to her you can see her throat gets all choked up and her nose goes all red and eyes water up. She is scared she has cancer, and she may well have. I try to be supportive, though also try not to falsely re-assure her. But there is really only one phrase that will take her ache away. She wants someone to tell her, her with her 3 young kids, that this is not a cancer. And nothing I can say or do from the bedside can help. I want to cry with her, but of course...for her sake, I don’t.

The only person so far, as a patient, that I have had to remove myself from the situation (ward) to cry for, was this little old tokelauen man. He was in his early 70s, and had 8 wonderful kids, all grown with their own families. He was crippled later in life from a nasty illness but had managed, despite having a wife who also developed dementia, to keep his independence and remain in his own home. His kids had developed a fearsome roster of care. So that they all took turns everyday of the week caring and providing for their parents with only the help of a district nurse once a day. He presented to hospital, only because a skin condition which he had, had flared up and was quite painful. To cut a long story short, that presentation to hospital, unknown to him, was his pitfall. Despite initially clearing up his skin, the hospital would not let him leave.

The managers and social services and government organizations were not happy with the home situation. They found it appalling, how could this crippled man and demented woman NOT be in a rest home with hospital care?? They were shocked that his family 'had to do' all his cares and showering and feeding etc. His house was deemed "unfit" for them both , there were no ramps and the corridors were too small and who was to stop his wife from wandering out the door and into oncoming traffic?? In the end, it took months to slowly get things into place.

They used me to translate alot cos the old man spoke no English, and only Samoan and Tokelauen. The old man, who was really on top of his game, intellect wise, could not understand. Tell them our pacific people don’t go into resthomes he said, tell them I have 8 kids, goodness they are going to look after me to the day I die he said. I tried to advocate for him, but "they" would not have it. They got ramps put in and hoists in the shower and a toilet by his bed and people to go in and check on them (because he refused to go to a resthome) special wheelchairs and beds with wheels, there were alot of delays because equiptment had to come from south island and australia etc etc, and in the meantime, he probably caught a nasty hospital bug from some other sick patient, and died in the hospital, still waiting patiently- to just go home to his wife.

He had asked me every single day, every single morning, when would he go home. He told me to tell 'them' he missed his wife, and he would be fine, not to worry about him. One morning I came to work and he literally took his last few breaths. My team stood around humming and haaing and trying to make it out as if it were a good thing, he had suffered with his illness and was old and weary, the tears turned on like a tap that day, no- more like a burst pipe on the side of the road someone had accidentally put a sapelu through. I had to leave because I was so angry. I was sad and angry and horrified. Horrified because he had not go to die in his own home, with his old and demented wife whom he had loved and missed so much. That he had spent the last few miserable months of his life, in a stale and lonely hospital room, waiting for beuracacy to tell him how to live his life.

Anyways, so thats my crybaby story, as for today, ia..I have had enough of my share of tears...now I am going to have a shower, make some dinner, and try to shake off my work invisible jacket, which carries so many woes, and watch "Americas Funniest home videos" ..and try to laugh.