Tuesday, April 23, 2013

Palliative Care . . .


Whenever we talk about Pallitative Care, the 2 groups of patients who come to our picture are those who suffer from stage 4 malignancies or hiv-aids. At NJH, we’ve another group who  comes to us for end-of-life care.

Last week, we had one such patient.

Mr. GD suffered from severe breathlessness and he could not maintain his saturation to even 80% on room air. He looked quite familiar to me. Later, I remembered. He had come to us more than an year back. We had diagnosed him to have severe bronchiectasis secondary to tuberculosis.

He had already taken Anti-Tuberculosis medicines twice.

The family had already spent quite a lot of money for his treatment when I saw them last year. They were planning to sell their land and do further treatment.

And now, when I saw him last month, the family had already sold their land and spend about 400,000 INR over the last year. They had hardly any money with them.

On examination, in addition to the bad lungs, he also had a very bad right heart failure,  severe ascites, secondary bacterial infection in his lung. He responded to antibiotics to a certain extent.

His dependency on oxygen decreased from 5-6 litres per minute to half a litre per minute over the first 3 days of admission. But, he remained sick. He started to have evening rise of temperature.

To our surprise, his ascitic fluid examination showed that he had tuberculous peritonitis.

There was no way that his family was going to take him elsewhere for further treatment. After selling all their land, the only thing left was their house.

GD pulled on for about 3 weeks. He always needed at least half litre of oxygen. Ultimately, his heart gave up and he died.

The issue was his bill. We had already told the family that he would not live for long. And whatever we did was to ensure that he lived without pain. And it was expensive. The total bill came to 61,000 INR. I was sure that the family did not even have money for food.

There were phone calls from quite a number of people. And one of the mukhiyas came. Everyone wanted to take responsibility for our writing off the bill.

Of course, it is tough. We are yet to have a formal palliative program. I wonder if it is time that we request people to support us in helping out with such patients. 

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