COTW: Buying Time

(from Eric)

Claudette was first admitted to the hospital 6 weeks after having a baby, just after the cut-off of getting "free" care from the government.  She had swollen legs and a blood pressure through the roof.  Her eyes were blurry.  She is 23 years old.  Her baby (as would be normal here) stayed with her, but (as would not be normal here) she was otherwise quite alone.  I believe she has a husband, but I never saw him.  We started her on some medicines, hoping that this was a weird late manifestation of a pregnancy complication, and that she would get better soon.

She felt better a few days later, and we discharged her.  She hung around, waiting for her family to show up and pay her hospital bill.  They didn't.  About a week later, still waiting, she got sick again, not having bought her outpatient pills either.  Blood pressure still high, this time with fluid in her lungs, making her breathing very difficult.  We admitted her back into the hospital and started her back on treatment.  We checked her kidney function, and found that she didn't really have any (in American units, a Creatinine of about 22, but in our units >1500, which makes it sounds even worse).  At this point her prognosis is getting worse.  The baby is still her only companion.  We don't have a hospital cafeteria (yet) and the other patients' families were helping her to find some food.

Somewhat against expectations, we pull her out of her crisis, tried to control her blood pressure a bit better, to protect what little kidney function is left.  Finally, she is stable, and we discharge her again from the hospital.

She waits some more.  No one comes.

On the day that we admitted her to the hospital for the 3rd time (due to another downturn in absence of appropriate support), a family member shows up.  They want to go home.  I don't blame them, but now is not the moment.  I know her prognosis is poor.  I know we can't change that.  I want her and her baby home, too, but I think if we wait a day or two, we can get her a longer stay at home before she gets home.

We're buying time.  Often, that's exactly what we're doing.  It's the reality of medicine in a mortal world.  Even if you "save a life" of an otherwise young healthy person, you're really "buying time", just more of it.

In a sense, that's what we all want.  More time.

For Claudette, for her baby, there's not that much we could do to buy her much time.  She needed dialysis weeks ago.  She needed intensive monitoring of her blood pressure and her electrolytes.  And she didn't get that.  But hopefully she got some time.  

And maybe we would all do well (since we are all in the same scenario after all) to shift our focus from the amount of time to the type of time, the quality of the time.  Time for Claudette to be at home.  Time for her to share in family meals.  Time with her baby.  Time for her baby to get week-by-week a little older, in hopes of doing better when Claudette is no longer there.

After a couple more days and a couple more discussions with Claudette and her lone family member, we sent her home, paying for her hospital stay from the Needy Patient Fund.  The fact that I haven't seen her now in a few weeks is potentially a good sign, but not necessarily.  But my time spent with her is, at least, a good reminder.  The importance of the time we have.  The importance of how we spend this time.  May it be well-spent.