Monday, February 22, 2010

On Breaking the Cycle

I've been silent here, but it has not been for lack of things to say. There's been much happening, and much thought, but very little time to be reflective. Many things I've wanted to write down, but not exactly compelled to write down. Until now.

My husband has had this patient for the last few years, a young woman in her early 20s with bad disease, a history of less than stellar life choices, and sketchy family support. SH. When my husband met SH, she had two very young kids but the dad (dads?) was nowhere in sight. The woman's mother (younger than me) - and grandmother - were not exactly pillars of appropriate behavior and choices. There were no fathers or grandfathers around for any of them. Very little stability.

It's been up and down with SH over the last couple of years. My husband is very good about HIPAA and doesn't reveal identifying details to me when he talks about stuff at work - I didn't know SH was "S" until December, and just learned the "H" this morning - and it's rare he talks about patients at all. But sometimes he does need to talk about what he's seeing, what he's treating, and how hard it is. SH was always a challenging case from a patient compliance AND severity of disease standpoint. Still, he fought for her as best he could. There was something about her - the rough around the edges young woman (girl, really) who deserved a chance to break the cycle of the generations before her. Even though she hadn't been particularly successful in that so far.

SH was post BMT and doing okay until November, when she contracted H1N1. It's been a rollercoaster since then, emotionally draining on everyone. In some senses, the staff knew SH wouldn't make it and arranged for her kids to get into the normally strictly controlled ward so they could have Christmas together. But SH hung on.

Before we left on our recent vacation, my husband made sure SH was squared away as best he could. That she was as stable as he could help her be. But the experience with SH has been so draining that he really needed the week away from the hospital. Really, really needed it.

We only left town for a few days. We came home on Wednesday night. On Thursday evening, late, my husband went into the hospital to move some things around in his office so some painters could get in. While there he learned that SH had passed away that morning. Her lungs and her compromised immune system could just never recover from that virus.

It's always sad when a patient doesn't make it. It's always hard. People are always left behind. There's always hurt. But this case feels a little different. Like SH never got that real shot at breaking the cycle, really learning from the past and moving into the light of the future. Will her sons have that chance? I don't know.

There are ways in which I think SH was very attached to my husband, but not in any way that would make me remotely jealous. I think my husband was the first male in her life who didn't stop fighting for her, who didn't walk away even when she was hard to deal with. (And she could be very juvenile and hard to deal with.) I think she needed that as much from him as the chemo and the other treatments. I'm glad he could give it - even though in the end he couldn't save her.

SH's body is still in the hospital morgue. Her family is struggling with finances to have her remains cared for properly. I think about her two little boys needing to say their proper goodbyes, about her mother getting another chance at raising children, about whether they'll be able to break their cycle. I hope they do. For SH.