We load Carlos onto the stretcher with terrific care. He barely weighs 120 pounds, McHottie could have picked him up and placed him there all on his own.
The ride to the hospital is close to an hour long. We pass three hospitals along the way there, and it frustrates me. Stretcher rides are not comfortable. He's jaundiced. His BP is in the tank, or heading that way, at 80/48. He hasn't dialized in five days. He's breathing at a rate of 12. The only words he mumbles during the transport are "frio" and "duele". I took two years of Spanish and they were more than a few years ago, but I remember the words cold and pain. I pile some bath blankets on him and try to get him as comfortable as possible.
We walk into the registration area on the main floor of the hospital.
"Would you mind getting him registered?" I ask politely, handing McHottie Carlos's packet of paperwork. He heads off to the registration desk where there is just one person in line.
I turn my attention back to Carlos. "It looks like it should only be a minute, hopefully they'll get us back in a---" Without warning a group of concerned faces charge us. Everyone starts talking at once.
"Dad, how are you feeling?"
"Dad, was the ride okay?"
"Dad, did you eat today?"
We were swamped by seven of Carlos's grown children, and two grandchildren. Carlos barely sees them. He doesn't respond verbally. One by one the joy his kids had originally just to see him turns to disappointment and concern at his condition. His granddaughter starts to cry. I hold my ground and refuse to leave his side.
"He's doing okay," I assure them. A nurse is motioning to me to bring Carlos back to where the exam rooms are. McHottie reappears with a look of total shock on his face at the number of family members there. Very rarely do we have more than one person show up to see a Doctor with one of our patients. More often than not we are the only ones there for our patient. More often than not we are their family during visits like this. We are their advocates.
There's no way there will be a room big enough for all of us.
The Nurse proves me wrong. The room she has for us comfortably holds the stretcher, all of Carlos's family and the medical staff.
McHottie and I lower the cot down so that the shorter family members (and the doctor), can have better access to Carlos. McHottie retreats to the waiting room while I hide in the corner out of the way. Our rules state that if the patient comes on a stretcher we can't move them to any bed that doesn't have rails. There's no such bed, so for the time being Carlos has to stay on the uncomfortable stretcher.
I'm glad that his family is there. I love the fact that they're fussing over him. Too often my patients are all but forgotten by their families once they go into a nursing home. My heart is breaking for him because of his health, but I'm grateful his family is there with him.
They talk about the last visit they had with this Oncologist about a month ago. The oldest daughter seems to be the designated expert of the family. She's a Nurse at another local nursing home. She's researched his cancer, the mortality rates, the treatments, and the best Doctors in the area. This is not one of the Doctors on her list, and she's very vocal about it.
"I just don't trust this Doctor. I want him seen up at Big City Hospital. They have inhouse dialysis. They have a Cancer Clinic. I want a second oppinion. I want someone who is an expert to see him." She's scared, her voice is cracking.
When the Nurse comes into the room to take Carlos's vitals the family beg her to get him some pain control. McHottie has already made her aware of his pain. The Nurse does a fantastic job of assessing Carlos and getting his vitals in spite of the family. She quickly retreats to find a syringe and a vial of Morphine.
I ask the family if they would have a problem with me sitting just outside the room so that they could have some privacy. They thank me. I let them know that I'll be just outside should they need me.
"You know, this isn't nearly as funny as I remember it being," He says sipping on his hot chocolate.
I nod my head, deeply engrossed in a slow cooker recipe for pulled pork. It sounds and looks delicious.
The Doctor emerges from Carlos's room looking particularly grim.
"Hey, I'm going to go check on them and see if they need anything." Now McHottie nods, deeply engrossed in a pre-cracked out Dana Plato.
I knock on the closed door and poke my head in. "Do you need anything?" Three men leave the room and begin a hushed conversation outside the door.
"Ma'am, could you put his head down a little? I think that might make him more comfortable, " The Granddaughter asks politely.
The hushed conversation in the hallway is getting louder. I hear the words "Three weeks" very clearly. My heart sinks a little more. Carlos is staring at the ceiling with his hands folded on his chest. I look to the eldest daughter, whose eyes are red from crying. "Ma'am, are you okay?"
She shakes her head and breaks down. "They told us he had two years to live four weeks ago. Now they're saying two, maybe three weeks. I don't understand..."
Everyone in the room is crying, some sobbing loudly, some just wiping tears away. I don't have anything to say, it's not my place. I put my hand on the daughter's arm and let her know that I'll be outside, and that if the family or Carlos needs anything to find me. She thanks me yet again.
"So it's just a few weeks then..." I finish telling McHottie what had happened in the room. Tears are working their way down my cheeks. "I feel horrible. I feel bad that we assumed right off the bat that he didn't need a stretcher. I feel bad that we didn't want this run. This is our job, right here..."
"Epi... There was no way for us to know. Think about him a week ago. He was walking around. He practically jumped onto our cot. He was talking and pissed off about having to go to dialysis. Cancer is a sick bitch." That's my McHottie, the voice of reason.
The men in the family have settled down and rejoined the women in the exam room. A random daughter close to my age pokes her head out and motions for me to come to the room. I stop at the door before coming in and ask her if he's okay.
"Dad's fine, but could we have another blanket?"
Of course you can.
When I return with the last of the bath blankets on our truck the family is yet again divided. Decisions are being made, voices are raised, people are still crying. I feel awkward witnessing this, as it's such a private matter, dealing with a dying parent. It's something I've been through with my Grandmother. It's gut wrenching. I let them know that I'll do whatever I can for them.
A voice pipes up from the back of the room, "Can you take him to Suburbia Hospital?" The voice belongs to the youngest son.
"He can't go to Suburbia, there's no inhouse dialysis there." Eldest daughter reasons. "And it's out of the way for everyone to visit. He needs to go to up north. Mayfly General." She looks at me hopefully. "Can you take him to Mayfly?"
"Let me check with dispatch on things. Typically it's not a problem."
"McHottie, looks like we're taking him to Mayfly. They want dialysis."
"I don't understand that, why? Why put him through that?"
"I don't know. They're not ready to give up I guess." I understand what that feels like.
I walk back to the room and meet Eldest daughter at the door. "Ma'am, we're going to take you wherever you want to go. Do you have a Doctor who will take him on up at Mayfly?"
"What do you mean?" She's confused.
"Do you have a Doctor who is going to directly admit him? Otherwise he has to go through the ER... And there's no guarantee that they will admit him through the ER. They could just send him home from there."
Granddaughter approaches us and puts and arm around her Mother. "Mom? Is everything okay?"
Her Mother is falling apart in front of me. "I don't know what to do. I don't understand what you mean. I want him in that hospital. I want him to have dialysis."
She wants her Father to live.
"Ma'am... Have you asked him what he wants to do?"
"What who wants to do?" She asks wiping away tears.
"Your Father. Have you asked your Father what He wants?"
She closes her eyes and realizes that she has not. She hasn't asked, in fact, no one has.
They teach us in school to be an advocate for our patients.
Human Nature leads us to care for the families by extension.
When the families wishes and the Patient's wishes collide... It's not something they teach you to deal with in school. Obviously my Patient's well being is my primary concern, but at times it's easy to want to do everything you can for that grieving family, and in turn temporarily forget who it is you're really there for.
Not a new one a hundred miles further away.
Not a Hospital with a state of the art cancer center.
Not one with in-house dialysis.
The family contacted Hospice that day.
It was with a bit of a heavy heart that I realized the following day that he wasn't going to continue with dialysis at all. I understand it, I would make the same decision. But knowing that I probably took him for his last trip outside into the world, into the sunshine...
It broke my heart a bit. For Carlos and his family.