#11 All We Can Do

 I sent home a woman with a blood pressure of 200/100. That was after I maxed out her atenolol, enalapril, hydrochlorothiazide and spironolactone. Those are all my medications!!! I can't test for other causes of hypertension. I can't even check her kidney function or electrolytes! I told her family, ‘We’ve done all we can do.’

I gave atenolol and omeprazole orally as a last-ditch effort to decrease the variceal pressure of my tuberculosis patient who also happens to have cirrhosis, massive ascites, icterus and is vomiting blood. I told the patient and his family, ‘We’ve done all we can do.’

I sent home a young boy would could barely breathe. He has Burkitt’s Lymphoma, a very treatable cancer. It grows extremely rapidly, horribly disfiguring the face, but because it grows so rapidly, it’s extremely susceptible to Cyclophosphamide. However, this boy’s tumor was so huge and so advanced, it wasn’t responding to treatment. The tumor continued to grow, entering his mouth and making a slow but steady progression across his mouth. He could no longer eat one day. The next, he could barely breathe around the mass. I told the father that I could perform a tracheostomy, but that the mass would continue to grow and his boy wouldn’t be able to talk. The father said there would be no point to that. I told the father, ‘We’ve done all we can do.’

Now we only have three or four more doses of Cyclophosphamide left. I will need to tell these kids and their families, ‘We’ve done all we can do’ before we even do anything.

It’s easy to speak frankly with people about death here. You can tell the patient they will die soon. You can say it to the family. They are accustomed to death. Death is a recognized and acknowledged part of every life.

You just wish you could do more before you look them in the eye, still full of understanding, and say, ‘We’ve done all we can do. At this point, we can only continue to pray. We know the Great Physician, who can heal all disease. We can only continue to leave it in His hands now.’

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