*All names have been changed to protect the identities of the patients and Nursing Sisters.
The first stop of the day is to visit *Theresa, a woman in her mid-twenties who has an eight-month-old baby. The young woman is lying on a bed in the domestic living quarters of her aunt’s place of work, dressed in a nightie, with her plump, happy baby sitting beside her. She noticed a small lump in her left breast when she was only a few months pregnant, and in a very short space of time it had quadrupled in size. Today, Theresa struggles to walk and use her left hand, having received the diagnosis of an aggressive breast cancer (and the lump by then the size of a tennis ball).
She had a mastectomy to remove the breast and soon thereafter the disease was found in her spine. Radiation treatment followed, and the brave woman will begin chemotherapy soon. *Theresa’s mother has come to Johannesburg to help take care of her daughter and granddaughter, and HospiceWits’ Sister Ingrid visits weekly to monitor the patient, provide palliative care, words of comfort & advice, and to ensure that the young woman’s pain is under control.
We’re now on our way to visit a new, elderly patient, *Mrs Patel. Her family is very concerned about her – she’s bedridden and has several health and joint problems including severe rheumatoid arthritis. A domestic worker takes care of the 84-year-old, but one of her daughters lives close by and spends a large part of the day with her. *Sister Ingrid takes a careful and detailed history, after which she addresses the patient, speaking slowly and clearly to the hard-of-hearing little lady tucked up in bed.
After first checking her vital signs, and then inspecting her body for bedsores, Sister recommends they employ an experienced day nurse to assist in turning the patient more frequently, and to give the family some respite from the physically demanding aspect of caring for their mother. There are six siblings, and they will share the cost of employing a nurse.
A phone call is made, and Sister tells the family the nurse will arrive at 08h00 the following day. *Sister Ingrid also suspects the old lady has had a few small minor strokes, and tells the family she will arrange for the HospiceWits doctor to do a home visit. One of Mrs Patel’s sons arrives before we leave, and the siblings seem so grateful and relieved that HospiceWits will visit frequently and advise on the best treatment for their much-loved mother.
By this time it is late morning and there are two more patients to see. We drive to Auckland Park to visit a lady with advanced lung cancer. *Betty’s home-care assistant greets us with a huge welcome, and soon Betty appears and hugs both Sister and I. Still mobile, this tiny woman chose not to have the conventional chemotherapy treatment, and she has been in our home-care program for a couple of years now, and is getting very frail. She orders coffee and biscuits for us, and Sister starts asking how she’s managing her pain and other symptoms.
They discuss various aspects of the prescribed medication, and Sister advises Betty that she should see her home doctor about an issue unrelated to her cancer. Of concern to Sister Ingrid is the fact that when the nurse is off-duty on a Saturday, the old lady prefers to be on her own, and to have the house to herself.
Although Betty says she carries a panic button around her neck, Sister makes it clear to her that she could have a fall and be immobile on the floor injured, without any help. Betty is quite unperturbed, and relishes her Saturday solitude. We finish our coffee, exchange hugs and positive wishes, and slowly make our way to visit our last patient of the morning.
*Jonathan, a retired medical specialist with advanced prostate and bladder cancer, lives with his elderly wife, Molly. He is bedridden and looks terribly ill. Molly suffers from severe back and joint pain, so the two of them are permanently side-by-side in adjacent twin beds.
They have a live-in lady nurse/assistant who does their shopping, cooks and cleans for them. In fact, she does absolutely everything for them. Sister Ingrid pops in regularly to see how they are doing, takes their vital signs, checks their medication and advises on any other issues that are concerning them. As this is a particularly tough caring role, they work through an agency that provides suitably qualified individuals to help the couple from time-to-time. I find it particularly disturbing that the couple does not have any children to help care for them.
The house needs a coat of paint, lots of maintenance work, and is very untidy. After we say our goodbyes I remind myself that when you have a terminal illness and are confined to bed, there’s probably no point in being concerned about something as trivial as painting the house.