Home Visits: Day 3 (Trivandrum)

            Today I stayed in the city of Trivandrum with Dr. Annama, Abbey (another Iowa student), and the Pallium nurses, Danielle and Sharon. It was my first day working with Dr. Annama, and she couldn’t wrap her head around my name being Hunter, so I told her that my middle name was Charles and we both agreed that she would call me Charlie instead. We were without a volunteer today, and I was able to see what a huge wrench that threw into our schedule, as we kept getting lost and having to stop and ask directions between each patient. Between that, our honk happy driver, the bumpy roads, and a high of 90 degrees, it was a long day. That being said, I learned more today than any other heretofore, as we were able to see a wide variety of diseases, conditions, and clinical practices. Again, I will outline those that stood out to me in the following paragraphs.

            The first of which was an 88 year old man that had diabetes, early stage Parkinson’s, and esophageal cancer with metastasis of the lung. Upon entering the home, I noticed that there were lots of family members present. When we entered the patient’s bedroom, they were all eager for him to be seen, and you could tell that he had been very well taken care of by them. The patient was extremely thin and was bed ridden; the maximum amount of movement he was capable of was to turn onto his side. The visit went on as it normally would, with Dr. Annama assessing the patient’s pain and giving him the appropriate treatment for it, and we left the house and bid our farewells to the family. Dr. Annama then explained to us that they had received the diagnosis just one week prior to our visit, and that the patient had been up and walking around like normal just 10 days ago, before he began his rapid deterioration. She believed him to be very near the end of his life, although the family claimed that he had been doing slightly better since his son arrived, after which the patient became much happier and more alert. It was amazing for me to see the entire extended family come together and care for their loved one during his final days of life.

            The next patient was a 47 year old man that had been hit by a car while riding a bicycle 6 months earlier, which resulted in a traumatic head injury that had caused a midline shift and an epidural hemorrhage (bleeding in the cranial cavity) which required a craniotomy to stop the bleeding and relieve the pressure. When we arrived, the family gathered in the room and the neighbors came to observe through the open window, and you could tell that everyone was very concerned for the patient, and which showed the culture of openness and mutuality that is present in their culture. We began examining the patient and noticed that he was “awake” but unresponsive, and that his pupils did not respond to light stimulus. We also saw that he had a nasogastric tube (a tube inserted into the nose, down the throat, and into the stomach that is used for feeding) due to the fact that he was unresponsive and therefore unable to swallow, as well as a urinary catheter. His breathing was labored, and was accompanied by a painful moan at times. Abbey, the other Iowa student who will graduate in the spring with her B.S.N. explained to me that the man was in a decorticate posture, meaning that his arms were fixed in a flexed position, or bent inward on the chest, his hands were clenched into fists, and his legs extended and feet turned inward, which is indicative of severe brain damage. It was heartbreaking to see such a relatively young man in such a vegetative state, which had been one day been imposed on him so incredibly suddenly.
          As I type this blog post I am still fascinated yet saddened by the unfortunate circumstances of the patients we saw today. I feel as if this is probably the most hands-on learning I’ve ever done in one day, and am extremely thankful for having been given this opportunity. With that, we are halfway done with our home visits, and are nearing the two week mark of this three week long journey. I can’t believe how fast it’s going, but I’m doing my best to act as a sponge and soak it all in before it’s all over. Farewell for now, as I am off to ZamZam's restaurant to eat dinner, as I hear they have oven roasted chicken that is out of this world good. Thanks for reading!

Father and son hold hands while sharing a moment of the father's last few days of life.

One of the patients lived with their family in a more rural area, where they were able to grow crops and own chickens to feed themselves and to sell for money.

Sharon and Danielle, the Pallium India nurses.

A family member of one of the patients and I as we departed from their home.