It’s hot. There’s no privacy. People are everywhere. In cots, on mattresses, crammed up against hospital corridors. Family belongings stuffed into plastic bags and paper-thin sleeping mats lay tucked under beds. A limp baby. A tired looking Grandma. There’s no escaping the pain, exhaustion and uncertainty in these people’s faces.
Today was confronting. I knew it would hit me eventually. Like the moment before you stub your toe. Bang.
This morning we were taken to a large children’s hospital in Ho Chi Minh City. With our interpreter alongside us, we slowly moved through the paediatric oncology unit, speaking and listening to the children and their families. Staff work very hard and do a fantastic job in these units.
Before entering the unit we had made a conscious decision to bring joy to these children. We had brought stuffed koalas, kangaroos, pens and other bric-a-brac you’d find at the Queen Victoria Market in Melbourne, Australia. Whilst every child, parent and grandparent left an impression on me, our very last visit is one that will stay with me forever.
Next to the nurses’ station, as in most units, is the room with the sickest patients. An 18-month old boy with Down’s syndrome fidgeted where he lay. He had recently had heart surgery but was now septic as evidenced by a widespread red rash covering all of his tiny oedematous body. By his side sat a distraught looking mother, a grandmother with a defeated look on her face, and his father who was beautifully fanning his baby, so gently, doing anything he could to ease his discomfort.
We – an Oncology nurse, a Palliative Care Consultant, and myself – were asked if we would do anything different in Australia. Was he receiving the best care? Our answer, of course was, “Yes! He is.”
As our conversation continued, I could feel my eyes begin to well up with tears. His mother knew that the chance of survival was very slim, but she was concerned he was suffering. At this point I was so glad I had a Palliative Care Consultant by my side. He did such an amazing job, listening and speaking to them. Yes, she would know when the time was right to stop active treatment. No we don’t know how long it would take for her baby to die.
As challenging as it was to hear their pain, to see their suffering and unimaginable distress, I am hopeful that we have enabled her and her family to feel greater clarity in any further decisions they have to make. Maybe they now feel more confident and able to have the same conversation with the treating team looking after her son. Maybe they would feel more prepared to discuss comfort care rather than aggressive treatment. Maybe his mother would know she has really done something towards relieving the suffering of her son.
The afternoon brought an opportunity to engage in different professional nursing activities—this time to provide education. I presented a lecture on pain relief, including assessment and management, to about 50 paediatric nurses. It was well received, with even a few questions and laughs along the way. A big thing amongst a shy audience! Yet, as with all education, the prospect that a child’s pain may be improved as a result of my talk is certainly heartening and I felt a good sense of achievement as a result.
As I sit comfortably in my air-conditioned hotel room about to head to dinner I know I will never forget that young boy and his family.