Man knows not his time...

4-17-08; Rather interesting day today on rounds. I have this patient, Kenneth with TB meningitis and AIDS. I had inherited him from the physician who was previously on the service. Last week I thought he was getting better and had tried to discharge him. However his family was reluctant to take him home for fear he would die there. It is similar here as it is in the states, we want all our dying to be done in the neat and tidy environment of the hospital. While in the states it is likely due to the fact that we want someone else to clean up, here it is likely due to the fact that if someone dies in the home, unless everyone in the community is expecting it and ready for it, the immediate family may be blamed for not intervening. So it is sometimes easier to allow death in the hospital than explain to everyone in the community what is happening, especially with AIDS.

So back to rounds. I see Kenneth, he is not alert, this is no different than usual, he has meningitis. I listen to his heart, lub dub, lub dub, lub dub… I listen to his lungs, raspy breath sounds are present. I then go on to finish rounds on the rest of my patients.
Later in the morning the nurse calls me as the wife and sister have come to see Kenneth. I talk to them about Kenneth’s grave prognosis but give them hope that Kenneth may recover. They leave and seem happy that everything is being done.I then go to finish some notes.

Not ten minutes after I had the conversation with the family a nurse interrupts me, “Dr Temple, are you taking care of Kenneth?”

Not looking up from my notes, I respond, “Yes.”

“Can you come examine him with me, I think he has passed,” she says cautiously.

I look up from my paperwork and sure that she has the wrong patient and is mistaken I return, “Are you sure, I just examined him, and the family was in there with him, he was most certainly alive?”

“I am quite sure Doctor, please examine him with me.”

We go to the bedside and examine him, he is still warm, eyes are open with a glassy stare. Life has passed from him.

Man, and often physician knows not the time…

“Should we call the family and let them know to come back?” I ask.

“No. When they return, he will not be in the bed and they will know.”

I think to myself, “What a cold way to inform the family.”

However that is the way it is done here. Even with the pervasiveness of death, Kenyans are reluctant to talk about it and seemed surprised when told someone will die. Therefore patients and family members are often passively informed of the diagnosis and prognosis. Very different from our Western way of doing things where we want to know everything. Neither is wrong or right just different…