caringspain.com

A case history

Here is a story from just before the end of the 20th Century ! History might repeat itself : there is a lot here to think about and we warn you that this case history is not for the squeamish. If you’d rather not read it, just send a donation instead !

Care has been taken to ensure the individuals concerned cannot be identified by the reader……

Alfred and Mary had lived modestly for some years as official residents of Spain on a quiet urbanisation until in the early autumn, at age 70, he was admitted to a Costa Blanca hospital with a respiratory infection, admitting cheerfully to having smoked a packet of cigarettes a day for the last 50 years…

The lung specialists at the hospital found a cancer in one lung and sent him to second hospital which specialises in oncology (cancer treatment).

At the second hospital, more tests were carried out. X-rays showed that the cancer had already invaded the left lung from the right one. A CAT SCAN revealed further difficulties: there was a nodule 2cm across in the main bronchial tube (airway) and cancer was already infiltrating the area where the main artery to the left lung was leaving the heart with blood under pressure. There was another lump growing on his left suprarenal gland (above the kidney) and this showed signs of necrosis (that is, the growth was rotting within him because, perversely, it was cutting off part of its own blood supply).

The medical reports containing this information were explained to Alfred, who was accompanied on his visits to the various specialist departments and consultants by staff from Mosaic ( the nursing, medical interpreting and support agency employed by Caring Together in such cases).

The Oncologist recommended palliative chemotherapy with three distinct drugs and after two repetitions of this cycle Alfred was showing a partial response. He was going home after each session and CT personnel were nursing him daily in his own home.

A further three cycles of the same treatment were agreed upon, of which Alfred received only two. He reached a point where he could not face up to staying overnight in the hospital for the next chemotherapy session, but asked for, and received, radio therapy treatment to help with his difficulty in swallowing. 5 further drugs were prescribed to ease his pain and help with his cough. Oxygen was on hand for use when necessary.

On 1st December his Caring Together nurse-interpreter had the unenviable task of telling Alfred that the Oncologist now thought his life expectancy was between four and six weeks - and that he should be allowed to lead his life as he wished.

He asked to be taken out in the afternoons in a wheelchair by his wife and Caring Together, still nursing him daily, supplied a specially light aluminium chair for this purpose, for Mary could not readily manage the normal sort of wheelchair.

A week or so after learning how few were his remaining days, Alfred decided he wanted to die in his home country. While making this possible for him, those doing so made sure he understood that he might not survive the journey.

Despite this unpalatable opinion, his desire to repatriate remained strong, so Caring Together summarised his recent Spanish medical reports in English in case this would be helpful “back home”. Because the Oncologist rightly explained that she was unable to issue a certificate of Alfred’s fitness to travel by air, family members in England pooled resources to hire a large, fast estate car which travelled to Costa Blanca with two drivers. They drove across so quickly that there was no time to translate the summary into French as well. Taking only three hours’ sleep on arrival, the three relatives began the northward journey.

As they approached the channel tunnel Alfred asked them to go faster because he did not think he could hold out much longer - but the driver was already going flat out, regardless of speed limits. They arrived at the home of a family member just in time. Within half an hour of greeting others of his family he began to vomit blood and died while doing so. He had achieved his last wish by living long enough to die back home.

Caring Together accepted all the costs of hospital accompaniment and home nursing from the time when we were first called to the time when Alfred left his Spanish home.

The story illustrates two important aspects of our work: to maintain the best possible relationships with the public health service and to maintain our capability to respond rapidly in order to assist a dying person to achieve what he or she wishes to achieve in the precious time that remains.