For fear of being judged…

This week on call was a tough one for me.  Every week on call can be difficult, but this week I encountered a situation that I still have not been able to fully process.

We admitted an elderly man early in the evening, in his 70’s, with ascites, severe abdominal pain, and hypoxia.  Lab tests showed bacterial peritonitis (an infection of the fluid that had built up in his abdomen) and Hepatitis C, with the beginnings of liver and kidney failure.  We put him on oxygen, and I started him on high-dose antibiotics.  He was unable to eat or walk.  I discussed all of this with his family the day after his admission, and they seemed to understand the severity of his illness, and seemed eager to continue his treatment.

That evening, after just 24 hours of admission, the family decided that he was not getting better fast enough, and so they wanted to take him home.  I explained that, due to the severity of his illness, if they took him home, he would most likely die on the trip.  I explained that the oxygen and antibiotics were the only things keeping him alive, and it would take more than 24 hours to see any improvement. 

It has been my experience here that families want their loved ones to stay in the hospital if they are sick, even when we tell them that the patient’s illness is terminal, and the patient would be more comfortable at home. They tell us taking them home is seen as abandoning them, refusing to help them, and this will cause the whole community to judge them. So this family’s request was very strange.  Strange not just for me, but also for the Cameroonian nurses involved with his care.  But they insisted “We will take him home”. 

So I asked some more questions.  They said, yes they were worried about cost, but their main concern was that, because the decision to bring him to the hospital had been theirs, if he died here, the rest of the family would blame them for his death. They believed that if they took him for the several hour trip over rough roads by a public taxi, they could deliver him to another family member.  It would be the other family member’s responsibility to take care of him and if he died there, they would not be blamed.

So they left – ending treatment, and refusing to take any pain medications with them.

No amount of reasoning by me or the nurses would change their minds.  I harbor no false hopes that he survived the trip.  I do pray he did not have to suffer long.  I pray that his soul is resting in peace. I can’t help but add to this prayer the hope that IF his family would be making decisions for another person they will be thinking more of the patient’s needs than how they may be judged by others.  And yet I know there are complexities to relationships, and responsibility here I cannot possibly understand.  This week on call was a tough one for me.