June 30, 2006

The Tongan Way

A lot of people visit our floor, but one patient in particular is quite popular. Around 8 0'clock when the announcement that the hospital's visiting hours are over, two dozen or so people come streaming out of the elevator bringing flowers, gifts and prayers. They talk with each other in the waiting room in Tongan while they wait their turn to visit room 31. I've heard soulful songs coming from his room, but he does not join in.

Mr. "Tonga" had been working out at the gym when he felt dizzy and collapsed. He was carried outside and he began to have ventricular defibrillation. With his heart malfunctioning, precious minutes were slipping away before his brain would start to die. CPR was administered and he was shocked three times before the paramedics arrived. He underwent emergency surgery by the request of his wife, but his condition did not improve. Oxygen deprivation had already robbed him of his higher brain functions. In just a few days, he went from pumping iron to getting pumped with IV fluids with a machine pumping his lungs.

His rapid deterioration must have been a shock to his family. I can understand their need to say their goodbyes, but as the weeks pass and he has shown no signs of recovery, long-term care is quickly becoming an issue. Hospitals have limited space and new people come in with problems everyday. Still, his wife still has hope for a miracle. His sister was flying across the Pacific ocean from Tonga to help in the final decision.

The decision of becoming a code III and be taken off of life support or going to a long-term care facility was not in his hands or those of his medical power of attorney (his wife.) The community helps him when he cannot help himself... that is the Tongan way.

This situation reminded me of another Tongan I met when I was shadowing an FP. Mrs. "Tonga" had a series of problems that she had been ignoring for too long. First, it was uncontrolled diabetes. She thought whatever happened was God's will... and medical intervention was not a part of the plan. Then a foot injury. Still, when things became unbearable, she found her way into the ER anyway. It was infected for two weeks before she finally came to the hospital. She refused to get amputated even though debridement had taken off the tissue on her foot all the way to the bone. Then she developed pancreatitis. She wasn't supposed to eat, but her family snuck food into the hospital for her anyway.

"Just let me go home..." she begged. "I'm going to die. I don't want to die here in the hospital."
She was fatalistic.

The FP was ready to let her go home, but she didn't want Mrs. Tonga to come back after her problems became even worse. The FP did not want Mrs. Tonga to think that she could make her own medical decisions and then change her mind and get "saved" by the hospital at a later time. She came back when repairing the damage and hoping things wouldn't get worse was all that a hospital could do.

The FP had legitimate concerns, but they turned out to be irrelevant in Mrs. Tonga's case. Before she left, she suffered from a heart attack. She was rescuscitated, but with similar results uncannily similar to Mr. Tonga's in my ward now.

Mrs. Tonga laid in the ICU for months, getting pumped with powerful antibiotics to combat the infection rooted in her foot, but growing through the rest of her body. She continued to get weekly dialysis, much to my growing puzzlement of the situation. Her care was transferred to a hospitalist and I lost track of her situation.

It is difficult to let go. Are those eyes tearing up because she hears my prayers? Or is it just because she cannot blink anymore and her eyes are dry? Is he clenching my hand because he is trying to tell me that he is still alive? Or is it a spontaneous clonic response?

It is hard to perceive how healthy someone is. Just because they can walk and talk without pain doesn't mean that underlying heart disease or diabetes will not emerge swiftly in unexpected ways.

It is hard not to judge people when they are put in difficult situations like this. Cardiac arrest used to be a fatal condition. Now that we can snatch people away from the brink of death, we are left with the uneasy consequences. Family members have to make choices that were once dictated by a tired body that just quit one day. Do you quit on someone that you love? How will that decision affect a community that is scrutinizing your every action?

Perhaps it is better that I do not know the ultimate fate of these Tongans. Their situations have touched me deeply and I do not think it would be right for me to pass judgment on their families for the personal choices they have made.

I do not know the Tongan way of doing things, but I'm trying hard to understand it.

1 comment:

  1. i was talking to someone (i forget who) about how we were both gonna tattoo DNR across our chests.