See here and here for starters. It has been a strange week all round really. With the main features seeming to revolve around life and its two extremes.
One one hand my sister's brother-in-law and his wife had a baby (well he didn't but you get the picture) on Monday - their first, and only 2 weeks late! I got the text about it on a day iw as talking to a patient on placement who was in for a knee replacement, and yet, had been swimming until 6 weeks before, helped into the pool by friends, because in the pool she could move freely and with less pain. She had been a runner from being you and ha been very active until her knees developed osteoarthritis about 4 years ago. They were the positives.
Then today I was writing up two cases. One is a woman whose son was horrifically injured 7 years ago, and who died last year. She herself has had Oesophageal and soft palate cancer for 7 years, and had a recent acute admission with gallstones. She spoke of the future with so little hope and expectation, and seemed to have a very low quality of life, due to her illness and the side effects of the vaious therapies. The patient is depressed, has problems sleeping and can only consume liquids, but still smokes 60 cpd to help with 'the stress'
The second is a lady with alcohol problems. She drinks a litre of whisky a day (28 units) at home, and sometimes goes out with friends. She was admitted with acute pancreatitis, and is the same age as my Mum, yet was very slow in spoeeach, tired easily, looked about 70, cannot walk waell due to bruises and breaks sustained whilst drunk. Her mouthw as a mass of ulcers, and her blood results indicate severe hepatic disease of one type or another, as well as acute pancreatitis and gastric erosion. Again, she had no hope for the future, and was convinced that only by drinking could she escapoe the situation she was in.
In both cases, I have struggeld in my write up to avoid being judgemental, and yet to try and understand their thinking, their viewpoint and how best to help them (albeit in a hypothetical Management plan). And yet, we get 2 or 3 such cases into the wards every week on this small unit.
So I find myself, having written both cases up, needing a small reminder of the positives of human nature, and why we as creatures care for each otehr, and as asociety why we demand that the NHS care for everyone equally regardless of status or outlook. I guess I'm tired and just a touch drained after 4.5 weeks in DEPCAT hospital.