Faith and the Faithful

“Your faith has saved you. Go in peace.” (Luke 7:50)

I suddenly felt myself in the middle of a Terry Schaivo case. I was asked to evaluate a patient for surgical insertion of a feeding tube. The gastroenterologist who called on me was a friend, who recently lost his mother to Pancreatic Cancer. He had tried unsuccessfully to place the tube percutaneously. The patient he needed me to evaluate was a young woman, 45 years old when she was first diagnosed with colon cancer five years ago. She had refused surgery at first, being of such faith as to want to leave things “in the Lord’s hands.” She finally agreed to surgery, which my associate performed, to uncover an advanced rectosigmoid colon cancer which had spread to multiple lymph nodes. He recommended she see a medical oncologist for further treatment. She refused any chemotherapy or radiation, wanting again to leave it in the Lord’s hands.

Now, five years later, she allowed herself to be admitted to the hospital, without an appetite, and unable to eat. There were two other people in her room, who introduced themselves as her husband and her sister. Each time I tried to speak directly to the patient they would call out, interrupt, ask me to be careful what I say, assure me that this patient was “at the end of her race,” although they were still “hoping for a miracle,” and seeking some way to provide her with the nutrition she needs. They complained about the medical doctor who had been assigned to her case, about the service and how paltry her meal trays were. They asked me about other surgical means of providing nutrition, central intravenous catheters and venous access ports. They even tried to take me aside to impart more of their insight into her plight when finally the patient called out, “Wait! I want to be in on this, please.”

Immediately I pressed to her side. Her face was gaunt, her cheeks hollow, her belly protuberant with a cancer—filled liver sitting like a loaf of bread at the upper part of her abdomen. I could see now why my GI friends had had such trouble placing a tube through the wall of her stomach. I wondered why they even had tried. She lapsed in and out of drowsy conversation. I asked her what she wanted, how she felt. She explained that her mouth was so dry, she could barely speak. I asked her to try to swallow, to try to eat. Her husband swabbed her mouth with a small blue sponge on a plastic stick . She said she would do her best. I told her I would, too.

I went out to the nurses’ station to write a note in the chart. I called my friend to tell him what I thought. I wrote in the chart that I did not believe that any further surgical intervention should be pursued. I reiterated that her prognosis was extremely poor. Her medical doctor had given her less than a month. I ordered her some high protein and calorie oral supplements in case she couldn’t tolerate anything else on her trays, and stressed that she should be kept as comfortable as possible and be seen by the hospice service. I inferred that she should be discharged home and allowed to die with dignity.

A beleaguered nurse (aren’t they all, lately?) approached me to find out what we were doing to her next. I explained my position, and she seemed relieved. “So, they are starting to get it?” she asked.

“No, I’m not really sure that they do.” I answered.

“Well, I’m not even sure who they are,” the nurse replied. She proceeded to describe the strange dynamic of her patient and her visitors. They had rearranged the bed and furniture in the hospital room so the patient would be facing a wall, where they had hung a large banner. I had noticed the banner and recognized the words as from the Bible’s Book of Psalms. I hadn’t noticed a picture, that the nurse described as strange and somewhat disturbing, although she had herself been raised in a Christian family she said it was not something she recognized as belonging to any particular Christian denomination. She said that the patient’s visitors were sometimes many and that they would stand around her bed and chant to heal her. The one woman who had introduced herself to me as the patient’s sister had even approached this nurse once and laid her fingers on her head and pushed her back with some force. She had questioned the nurse several times both about the patient’s food and her attending physician. Once, when the patient had refused to take a stool softener that was ordered, because she anticipated having trouble swallowing it, the visitor insisted that she need it and that the nurse should be more forceful with her patient.

The strangest part was a phone call this nurse received that morning. It was from a woman who introduced herself as a physician’s assistant and explained that she lived in California. The nurse said this woman was grief—stricken on the phone, sobbing that SHE was the patient’s sister and asked if “they” were there. When the nurse mentioned to the caller that her patient had many visitors, the caller sobbed some more and stated that “the Group” had not allowed her to communicate with her sister for many years, and that she had only just found out now that she was ill and that she was in the hospital. She said that she understood that according to HIPPA laws the nurse would not be allowed to discuss the patient’s condition with her, but she requested that if “they” were there, not even to mention that she had called.

I agreed with the nurse that this was truly an unusual situation and that the patient’s visitors were equally insistent with me. I told her how important it would be for her to continually remember who her patient was and to respect her wishes and anticipate her needs above all else. I closed the chart, left it with the unit clerk and headed for the elevator. I knew the nurse would try her best. I had faith that my patient would do her best. I believed I would, as well.