By Tedler D. Depaynos, MD
That is common to these patients are they were all in their eighth or early ninth decades which we sometimes call our twilight years. All of them also were from a common local culture.
She was a native of Taloy Sur, Tuba and because of an unexpected prolonged weakness and was practically bedridden for a week or two, she was finally convinced to be brought to the hospital. Although she was in her 8th decade already, she used to be still very active and kept going to her hillside farm which she had been doing for many, many years. When suddenly she felt sick, they thought that she could easily recover as usual, but this time her ailment seemed to be worsening and not improving despite the native ceremonies to drive her sickness away. Hence they convinced her to be brought to the hospital.
Initially, she consented to the oxygen tube and to the intravenous lines and injections. The following day, however, everyone was surprised that she wanted and even cried to go home already and kept on attempting to remove the tubes connected to her. Perhaps she felt herself progressively getting weak or perhaps she heard the doctors that came to visit her discuss her condition of having a chronic renal failure and needed a series of dialysis to survive.
We learned later that the patient passed away a few days after being discharged per request but before she died, she wanted to see her close relatives and neighbors and verbally requested that the 3 pigs she was raising would be butchered. She wanted to fellowship with them before going which surely made her happy.
Of course the event was re-enacted when she was permanently laid to rest.
Actually, in several instances convincing these twilight patients in going to the hospital may be difficult because they prefer to die at home.
A similar event happened to a close relative from Acop, Tublay who was unconscious for 3 days in the hospital due to a heart ailment. Upon recovery, he learned that many of his relatives, town mates and friends visited him during that time. He then insisted on going home and even tried putting on his shoes despite his severe difficulty of breathing. When his children objected because of his condition, he shouted that he wanted to die at home and not in the hospital. His children half-heartedly consented and he was finally brought home. Despite his objections, one of his sons butchered a pig and invited their relatives and friends for a get together especially those that came to visit him when he was out. The attendance was substantial and obviously the patient enjoyed the get together. Before dark, he called his son to tell him that his “expense was worth it” and he had to rest and sleep because the whole activity tired him. He was obviously very thankful and happy. Three days later the patient again was brought to the hospital and went into coma again. Sadly he never recovered. The son, however, was also happy that he made his father happy meeting his friends and relatives during the last days of his life.
Before a requesting serious patient is brought home, the members of the family should be consulted and bringing home the patient should be a family decision. If an untoward event occurs while the patient is being brought home, nobody should be blamed because blaming each other during the wake is apparently not good. Even in the giving of medicines or surgery, the consent should be a unanimous family decision.
This happened to a great grandma in a locality in Itogon. When the patient was confined, many of her town mates visited just to know how she was. When suddenly her illness worsened and she became serious, the relatives decided to bring her home. They were unprepared financially so that they pleaded with the attending physician to guarantee her bills so that she could be brought home immediately. Along the way the patient lost consciousness and they even thought that she already passed away. This was relayed to the waiting relatives thru cell phone and when they arrived, the whole community was practically waiting for her. When apparently she heard her relatives moaning she suddenly smiled and they even saw her open her eyes for a second or two. She appeared happy before she said good bye permanently.
When the relatives returned later to settle her bills her two children from abroad were complaining why she was brought home. In short they were not consulted when they even promised to shoulder their mother’s hospital bills.
It is also best to admit or refer a patient to an MD she could trust or is familiar with.
A female patient from Sablan, had apparently a mild stroke because she manifested a slight weakness on her right side and little slurring of her voice. Her relatives had a hard time convincing her also to seek medical consultations. After giving in to many of her demands which cost a dog and two native chickens, she finally consented to be confined for a day or two. The usual worked-ups were done and intravenous medications were started without any trouble. But when she learned that her attending physician was a certain MD whom she had a not so good impression, she started demanding that she should be discharged immediately. Apparently, two of the patients of the MD that passed away were her town mates and close friends and she was afraid that she will pas away also under the care of the same MD. The relatives were forced to bring her home and they were glad that she appeared to be “recovering”.
He was a successful businessman buying gold nuggets from the private miners. He smoked a lot but never been hospitalized. Because of ageing perhaps he finally succumbed to a progressive unceasing and very irritating cough that made him breathless and sometimes cyanotic. It was his first time to be in the hospital and happily his two children who were abroad came home to be with him. His condition however seemed not to be having any significant improvement and his stay in the hospital was prolonged. Because his children had to go back abroad so as to maintain their jobs, they decided to say good bye to him promising that they will return the soonest possible time. The patient however sensing that his condition would never improve and be left alone, he got mad and demanded that he should be brought home. Despite their pleas, he started removing all the connected gadgets supporting him. He wanted to die and be properly laid to rest with dignity in the presence of his children! The children and relatives were all with unceasing tears but they had to follow his demands. It was barely 24 hours after he was brought home that he passed away.
Twilight patients want to be at peace at home during their last moments. They want to be with their relatives and friends. Since the last sense to disappear is the sense of hearing it is best to talk to them even if they appear to be unconscious. They may respond with a tear or two or with a sudden flicker of their eyes. They do not like to die in the hospital if possible.
Some serious patients who want to go home may loss their life along the way so that the relatives are warned and advised that the patient should be informed. In these cases it is best that whatever they decide it should be a family decision so nobody would be blaming each other if any untoward incident occurs.**
