Get over it!

A couple of hours ago I was called by – again – the department of oncology, in order to manage an agitated patient. We’re talking about a man, 25 years old, admitted for the terminal stage of a lung cancer. He is married, father of 2 little children, has never smoked and is highly educated at university level. I am writing these lines for selfish reasons, so as to decrease a bit the impact of this case on my soul. If you’re not interested about unsettling details, please stop reading now.

First, I would like to tell you that the majority of people you encounter in everyday life are deeply schizophrenic. Why? Because they are completely cut of reality – the real reality that is real life. Most people play games in which they pretend they are something else: heroes, immortal gods, VIPs, all kind of masochistic idiots who find pleasure in being sacrificed, etc. Being truly in contact with your true nature is so rare that it is almost impossible to find someone truly real, that is, a truly real human being. Everything is about image, about the money you own or you could earn, about the power you have or you could have, about the clothes or jewels you put on your body, about politics and being right, or being with the right or the left or etc., about who you’re having sex with and how cool or hot that person is, etc., etc., etc. Pretty much everyone is schizophrenic because they live in 2 separate worlds that never intersect. However, the society has some rules that enable these schizophrenics to be socially acceptable and accepted, by using a common standard of political correctness so as to acknowledge that this psychosis is in fact normal, and those who see reality are labeled either as neurotics or unadaptable or… “mad in some peculiar way”. When you come into contact with reality – the real reality – some people give up their games, their illusions, their delusions. Others don’t. Oncology is one of those places where you can encounter yourself. Here you do not traumatize yourself. Here you traumatize the false image that you have about who you are or what this world is all about. Here you encounter the human nature as it truly is – vulnerable, stupid, imperfect, fearful – and here you see that your life isn’t such a big deal, you’re not “Hero X” or “God Y”, but only an idiot who believes in a self-made construct that is often far from reality.

Just sayin’.

When I heard at the phone that the patient is 25 years old, I said to myself that it must be some sort of suicide attempt following the news of having cancer. I didn’t expect to see someone dieing at 25. So I went to oncology with a completely different image and different expectations. The nurses told me immediately that I should see the patient first and read his files after. So I only asked to see his treatment. Painkillers and a generous dose of Haloperidol, an antipsychotic drug given for agitation or delirium. My second and last question was about his diagnosis and the prognosis. I simply asked if he is dieing or not. The nurses said he is dieing. That was all I needed to know. I switched from therapeutic thinking to palliative thinking, overlooking any potential medication side effects or altered laboratory tests or secondary diseases. When someone is dieing, you can’t care less about consequences that are otherwise of great concern in “typical medicine”. You care about 3 things: pain, fear and dignity. Period.

When I entered the patient’s room, I had to face the image of a heavily agitated bedridden young man, struggling to breathe while being continuously on oxygen therapy. The image is of someone spasmodically suffocating in front of you, someone in a terrible thirst of air, using all his thoracic muscles to vainly bring additional oxygen into his lungs, lungs that are compromised by cancer and are painfully ineffective. When you fall into water and you can’t swim and you are drowning, you’re doing it in about 5 minutes. Now imagine this agony for many days in a row… The patient was already exhausted by the effort of trying to breathe, while still painfully aware of his surroundings and perfectly capable of rational thinking. Besides the thirst of air, the patient was also driven by a massive anxiety… or should I say a profound and prolonged panic attack due to the fact that he was realizing he is going to die and he is actually dieing right… now.

Next to him and holding his hand while in tears was his mother. A relatively young woman, completely heartbroken, being unable to choose between screaming like a lunatic or being caring as a mother. The pain I read in the eyes of his mother was more brutal than the fear I read on the face of her child… or so it seemed to me.

I asked a couple of short questions and the patient replied surprisingly fast. He was completely coherent. He asked for something to keep his fear under control. I gave him some Xanax, against the recommendation that it should not be prescribed in cases of respiratory failure. As everybody knows (or should know), Xanax may depress breathing, but in cases like this, the clinical judgment decides against the book. The question is this: What do you prefer: panic or suffocation? I know, it’s hard to choose. That’s why medicine is so damn difficult…

After I ordered the nurse to bring the Xanax, I remained for a couple of moments watching the patient struggling to breathe. I tried to reassure him or his mother but it was to no avail. I felt I am the most useless being in the whole universe.

Actually, I felt exactly how I truly am.

Useless.

When giving up our self-importance and the illusion that we are somehow special, we discover that we are so damn useless.

When you feel powerless in the face of sickness and death, you finally cease to be a schizophrenic and you become – timidly – human.

Because, as I said many times in the past, being human is being vulnerable and small. Very small. Smaller than what our grandiose illusions made us believe we are…

I got out of the room of the patient and wrote my prescription in his papers, while the nurses told me the sedative medication was given.

However, after a couple of minutes and before leaving the oncology department, I wanted to visit the patient one more time. It is in my nature to be present when everything else fails, when I can’t help otherwise. It is my belief that my presence – or any human presence – is better than leaving the mother with his dieing son alone in the room. When medicine fails, a good word or simply being there is more than nothing, although I am aware that the patient is hours away from death.

I surprised the patient asking his mother again to hold him by his hand. He is afraid to die. I’m sure that in his mind there used to be a hurricane mixing his own fear with the fact that he leaves his mother and wife and children alone. But in the present moment he is focused on himself. Another illusion is falling apart. The illusion that we’re dieing heroically, “heroically”, thinking about the others. When you’re dieing you’re actually thinking about you and your own death. I never died before but judging by what this young man is doing and saying, he is focused on himself and nobody else. We’re self-absorbed around the moment of the great passage.

An inconvenient truth, eh?

He criticized me directly: Why is Xanax not acting fast enough? How much time is he going to wait until he is feeling better? I told him that it takes some time. But I failed to understand that “he has not that time to wait”. There is a sense of emergency, of urgency, of impatience, of restlessness, of exasperation, of… all the emotions happening at once.

I remain some extra moments next to the patient, talking to him and looking at his mother who holds his hand. He puts his chemo hairless head on the rail of the bed while his mother looks tearfully straight at me.

The air is cold because of the excess of oxygen.

I feel futile.

The air is also cold because I perceive the presence of death counting the seconds.

In the sudden silence I feel that perhaps the mother and the son need some private time and I am intrusive.

So I leave.

My job is done.

An hour later I phone the oncology.

He feels better.

I used to believe that PTSD happens only when someone goes in a war zone. Or is witnessing a terrorist attack. Or has an accident.

But it isn’t so.

That mother has felt, is and will feel powerless for a long time. I left but she keeps staying with his dieing child even now while I’m writing these lines. She cannot choose to escape that situation. She is trapped. She experiences pain, and uselessness, and helplessness, and hopelessness, and worthlessness of every possible attempt to save his child. Finally, she will have to bury him. And then she will have to live the rest of her days without him.

You cannot say to her: Get over it! or Time heals! or God loves you!

If this is not PTSD I don’t know what it is…

Some time after all has been settled, she will perhaps enter in a psychiatrist’s office and she will be prescribed some useless medication. And hopefully, she will also attend some useless psychology sessions in which a stupid psychologist will tell her:

Get over it!

2 thoughts on “Get over it!

  1. Carmen Cojan

    din nefericire….se intimpla in fiecare zi,Cezar.Aici au posibilitatea sa aleaga medical assisted death;si am apucat sa vorbesc cu o doamna care se temea foarte rau de ce urmeaza si voia sa aleaga in ce conditii moare.Tough!
    PS;eu cred ca noi ,cei care avem de a face cu aceste povesti triste,toti avem PTSD

    Liked by 1 person

    1. Poate ca ai dreptate. Dar din ce vad, cei care lucreaza la onco s-au abrutizat de mult. Stiu ca am iesit din salon si radeau in veghea de la 3 saloane mai incolo… Eu intrebasem asistentele daca sunt OK dar mi-au spus ca s-au obisnuit chiar si cu tinerii care mor. Onco e o specialitate pe care clar ca nu o voi putea face niciodata. Asa zic insa si multi despre psihiatrie…

      Like

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