The Patient (20 page)

The only part of his body that seemed like it hadn't been invaded was his feet, and she gently placed her hands on them, hoping that he could somehow feel the love she was sending him telepathically. How had they come to this? Why had life dealt them this blow? This husband of hers – who, until recently, was her partner, her rock – now looked more like a piece of meat in the butcher's window. She couldn't stand to see him like this and told the nurse that
she was going to go home for a sleep. She hadn't seen the girls for at least two days. Thank God for her father-in-law and her parents, who were taking turns caring for them.

Jonathan remained unconscious for the next 24 hours. Meanwhile, Derek arranged for his transfer to the public hospital.

‘Jonathan Brewster. Forty-eight. Cystectomy five days ago for T1 CA of the bladder. Suffered a bowel leak post-operatively. Laparotomy and repair yesterday. He has been stable since theatres. Drainage has been acceptable. Vital signs stable. No allergies. He is on antibiotics and had his last intravenous dose at 4 pm.' The nurse who had accompanied Jonathan from the private hospital was handing his care over to the Intensive Care staff at the Victoria Hospital.

‘Who was the surgeon?' the registrar said and flipped through the notes, which the nurse had just handed him. ‘Uh-huh, I see. Need we say more?' She gave him a knowing look by way of answer.

‘Hook him up, and let's get this show on the road,' the registrar said to the private nurse. He was keen to make sure Jonathan was stabilised after being transported from the private hospital. It was only 20 minutes away, but he knew that transport was a dangerous time for an unstable patient. ‘Put him in bay 6.'

The beds in the Intensive Care unit were in bays laid out
in a U shape around a central medical and nursing centre from which the staff could monitor all the patients closely. It was always a busy ward, but Jonathan had been ‘lucky', in that a 16-year-old drug addict had died a couple of hours ago, freeing up a bed.

In the bay to one side of Jonathan's was a woman who was fighting for her life after losing her unborn twins the night before due to her placenta coming loose. She had lost double her blood volume, any chance of having children and her uterus from emergency surgery. She had been trying through IVF for years to have children. Her husband sat in silent vigil next to her bed.

In the bay to his other side lay an 18-year-old motorbike-accident victim. A ventilator was driving his lungs up and down to make sure that they, along with his cornea, heart, kidneys, liver and pancreas, were well oxygenated so that they could be transplanted into recipients who were even now being matched throughout the country. Soon, he would be relieved of all his organs and allowed to die. In some ways, he had died at the scene of the accident, the force of which had converted his brain from a complex and miraculous computer to a mash of dead and dying cells, even though his heart continued to beat. Tommy's lights were on, but there was no one at home. His girlfriend, who had been riding on the bike with him, was now in the morgue.

Diagonally opposite Jonathan was a middle-aged diabetic man who had slept with a prostitute on a business trip to Hanoi and developed a groin itch. His frequent scratching of his scrotum had broken the skin, which then became infected. Embarrassment prevented him from bringing it
to the attention of his family doctor, with whom he played golf every week. His diabetes meant that his immunity was low, so the infection grew and festered. The skin over his scrotum began to break down, then so did that of his penis and finally the tissues in his whole lower abdomen. By the time the surgeons got to him, he had lost the entirety of his lower abdomen skin, as well as the skin of his penis, scrotum and groin. He smelt like a latrine. His infection was still spreading despite the extensive surgery he had undergone. Every treatment had been thrown at him, including the most expensive antibiotics in the hospital. Nothing was going to work. Within hours, he was going to be dead.

Working in Intensive Care is heartbreaking. The doctors there need to have deep psychological, spiritual and medical insight. They finesse the most technically advanced treatments and work miracles on patients who would have died without their specialised intervention. The heroic and often costly treatments coupled with the manpower ratio of over one nurse per patient make a night in Intensive Care more expensive than a night in a suite in almost any of the grandest hotels in the world. Many doctors call it Expensive Scare instead of Intensive Care. Despite the cost and the efforts of staff, the death rate is high. Doctors in Intensive Care wards are well advised not to get attached to patients, because a lot do not make it.

Intensive Care units are only ethical if we value the life of the individual above the community's well-being. This is not a belief that is held throughout the world – for instance, in Eastern thinking the community and family is more important – and nor is it in the interests of advancing the human race as a whole. This ability to put the interests of
the community and family ahead of the individual is especially seen in matters of marriage. To this day in India and the Middle East, marriage is not about love alone but about what is good for the families involved. In fact, marriage ceremonies in the Hindu tradition are more to unite two families than the two individuals. Yet, in the developed countries we hold the rights and interests of the individual ahead of the community, and the huge resources we apply to save a single child with an otherwise fatal deformity can make the evening news almost any night of the week. The lives that would be saved by applying the same amount of money to community-wide preventative treatments and policies is not newsworthy.

This would be defensible from a health-spending perspective if the money available for health was limitless. It is not. Making decisions where we put the individual ahead of the community means that we spend hundreds of thousands of dollars on experimental chemotherapy to gain an extra week of life for an individual with terminal cancer while we let the elderly wait 18 months or more to have a much-needed hip replacement or a prostate resection in our public hospitals. The health dollar needs to be prioritised, and society has been unwilling to engage in discussions about rationing.

More importantly, the developed countries are killing themselves with excess. The more that people eat, smoke and drink, the worse their health becomes. Creating a healthier community would drastically decrease our reliance on expensive hospitals and treatments, on antibiotics and operations. The cost savings would be enormous. It could be argued that closing every Intensive Care unit and placing the equivalent
expenditure into preventative health measures would far better serve the community. Stop people smoking, decrease alcohol consumption and get people to eat a healthy diet and lives will be saved, more lives than could be saved by highly technological Intensive Care units. However, our social system values the life of an individual above the good of the community, so we spend enormously on the prevention of death instead of the preservation of health.

Looking beyond our own borders at the global community, it is hard to see how it is ethical to spend enormous amounts on preserving the lives of individuals in Intensive Care units in developed countries while the same amount of money could be used to dig wells for clean water or provide nutrition to the millions of children who die each year of starvation and water-borne disease. If you happen to be born in a developed country, then your life is worth a million African children's lives.

Of course, it would be unpopular for a health minister to propose that we redistribute health dollars equitably around the world. The reality is that they would lose the next popularity-contest election, and none of them want that. Moreover, it is easy to hold this holistic point of view until it is one's own son, mother, father, daughter who is requiring the medical care. Then the cost to the community is far from one's thoughts.

In the Intensive Care staff's tearoom, the television was blarging the latest on the review of the Victoria Hospital. The health minister was standing at a press conference beside the chairman of the review committee.

‘I would like to thank the chair of the review committee for the thorough and far-reaching recommendations they have made, and I want to take this opportunity to say that I'll be implementing most of the findings of the review.'

The head of the Intensive Care department turned away from the screen, to the nursing-unit manager, and asked, ‘Did they manage to speak with you about the lack of resources here?'

‘No, I think they ran out of time. I heard they didn't make it to Anaesthesia either. It was the usual whitewash.' They shook their heads and walked back to the bank of monitors in the centre of Intensive Care.

The head of department looked down at the monitors and said, ‘Bay 6 seems to be a bit tachycardic. He might be struggling against his tube. Can someone check it out?' The registrar heard and heeded. He went down to the bay to see why the patient's heart was beating so fast.

Jonathan was trying to spit out the tube in his throat that was helping him to breathe. ‘What are his blood gases showing?' the registrar asked the nurse looking after him.

‘They're not too bad.' She was a middle-aged woman who had left nursing when her children were born and had returned as part of a government-funded initiative to address the shortage of nurses. One of the old breed of nurses, she could recognise a sick person from the end of the bed. She knew that Jonathan would be fine without his breathing tube in place. She didn't need the battery of blood-gas analyses to let her know. However, the medicine she was now a part of demanded that all of the tests were done prior to any decisions being made. She had returned after her sojourn to a health system that only
made decisions based on pathology or radiology confirmation. Without the numbers or the image, no decision got made.

The registrar did not examine Jonathan but looked down at the sheet of blood-test results. ‘I think we should take out his tube and put him on an oxygen mask. He might feel more comfortable.'

‘Thank you, doctor. I don't know what we would do without you,' she said sarcastically. He thought she was serious and puffed his chest out with pride.

Jonathan spent another four nights in Intensive Care, unable to sleep, eat or drink the whole time. He lost almost 20 kilograms and resembled a meaty skeleton lying in bed. The children were loath to visit him in hospital because they found it too frightening. Tracy made all sorts of excuses to him why they hadn't come – netball training, a friend's birthday party.

One morning, sitting on the recliner next to his bed while the nurse bathed him, he realised that if an attractive woman had been sponging his body in the past he would have been embarrassed at being unable to control his sexual feelings. Now, he felt nothing. The other thing that occurred to him as the nurse bathed him was just how ugly it was to have a bag attached to his abdomen collecting urine. He wondered how, if he was ever well enough to get out of hospital, he would manage to make love to Tracy. Would she be repulsed by this plastic bag on his side? Would she divorce him or have an affair? Had Jonathan had the energy for it, he would have cried. He just looked up soulfully at the nurse, who reported to the registrar later that day that Jonathan seemed a bit depressed.

Derek made an appearance late in the evening. ‘How are you feeling? OK?'

‘Well –'

Jonathan was going to speak, but Derek interrupted him. ‘Great, I'm glad. Look, the pathology results have finally come through from the cystectomy. The results show that we got the entire cancer out and the lymph nodes in your pelvis are clear.' He paused to allow Jonathan to thank him for the news.

However, Jonathan was taking in very little. He was quite embarrassed because he was actually sitting on a bedpan, trying to defecate. He had not opened his bowels for many days now – in fact, since before the initial surgery – and the nurses had told him that he was almost ready to eat, if only he could pass wind or open his bowels. He had been dutifully attempting to on a metal bowl, sitting up in his bed, when the surgeon had appeared and launched into his news about the results.

Figuring that Jonathan had no questions, he continued, ‘I have asked Dr Khadra to take over your care here in the public hospital. He is around here a bit more and can do what is required. I have discussed it with him, and he has agreed.'

As the surgeon walked away, Jonathan passed a rather long and high-pitched fart, which, thanks to the sound chamber created by the tight seal between Jonathan's behind and the rim of the bedpan, was amplified to produce a pure clarinet sound. For a moment, Derek appeared alarmed. He looked around, checking if it was a patient's cardiac-arrest alarm. Then he checked his beeper. Out of sheer embarrassment, Jonathan said nothing.

When the coast was again clear, he finally managed to open his bowels, but the effort exhausted him. He placed the bedpan on the stand next to his bed, put the cover on it and fell back into his bed and slept, too drained to celebrate being allowed to eat and the good news about his cancer.