The trainee GP, Hester, and I are going together to visit an elderly woman. She kindly thanked our senior nurse for the exams and hasn’t been to the office for years, so we don’t know her. When we walk in we are both shocked. Her belly is the size of a triplet pregnancy, but that’s not the diagnosis we’re thinking of.
She’s happy. A year ago, she had noticed that her stomach was growing a little with enthusiasm, but she ignored it. She always wanted to go see her daughter and grandchildren, who live abroad. And she wanted to finish a book. And that stomach didn’t bother me much, she said. She looks at us with a friendly smile and smiling eyes. She had such a good year.
In the meantime, she has stomach problems. She is starting to hurt and her big belly bothers her. That’s why she called, and here we are.
I ask what she expects from us. “I also know I have cancer,” she says. Her eyes are still shining. “Do you still want to go to the hospital?” Hester asks. She shrugs her shoulders. “Do what you think is best,” she said, “but no bell or whistle, you know. I just want to die a bit nice. “We are discussing the options with her. In order to take good care of her, it would help to know what is going on in her stomach, and the three of us decide that she will go to the hospital, but only suffer from examinations and treatments aimed at good palliative care and again as soon as possible.
Meanwhile, I see Hester’s eyes wander around his house. It’s a cross between a colorful bookstore and a boutique full of exotic trinkets. If it really was a boutique, I could spend hours browsing. I guess Hester’s thoughts: not really practical. We ask her if she has figured out what to do next if she becomes sicker. She prefers to stay at home among her books. While we agree that it doesn’t really fit into her interior, we all think it’s a good idea to order a high-low bed. And home care and pain relief – she’s okay with that.
Let’s go. “Are you not mad that I didn’t call earlier?” she asks. “Definitely not,” Hester and I answer firmly and in unison. Isn’t that the right choice for her?
Later at the hospital, 23 liters of fluid was taken from her abdomen.
In practice, Hester and I talk a little longer. What a charming and wise woman. She accepts what is happening to her and has made the conscious choice not to seek care sooner, fully aware that if she had come sooner, she could live longer. But just as everyone has the right to care, she also has the right not to want all the care possible. And what a good year she had.
Rinske van de Goor is a general practitioner.
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