Tuesday, January 10, 2006

Perspective

“No, I don’t want the line!” she sobbed.

I stood by her bedside, dumbstruck by her tears. “But Faiza, it’s just a Foley’s catheter. You won’t feel any pain. It’s a routine procedure. We do it all the time.”

Faiza was a young insulin dependent diabetic we had admitted for renal failure. The diabetes had damaged her kidneys and her nerves, including the nerves to her bladder, so that it couldn’t sense when to empty and ended up retaining abnormal amounts of urine. Urinary stasis is a common cause of urinary tract infection and our team had planned for Faiza to have a Foley’s catheter inserted into her bladder so that we could drain the excess urine. Women are more prone to urinary tract infection than men, anyways, even without diabetes, and with Faiza’s current renal failure, it was important that we protect her from infection.

But she wouldn’t have a word of it.

“I don’t care! I don’t want a line! Please tell them not to put a line in!” she cried to her mother.

I was lost. Faiza was usually a quiet and amiable young girl. Every time we came by on rounds, she would sit up, and listen patiently to our discussion, not understanding much but still attending respectfully to our inquiries. The chart said she was twenty but Faiza didn’t look older than twelve and the chubby cheeks and swollen appearance only added to the impression of youth.

“What are you afraid of, Faiza?” I asked, trying to be reasonable. “If you’re worried about it hurting, I promise you it won’t hurt. We use a local anesthetic while inserting and it’s all over in a few minutes. You won’t even feel it.”

“No! I don’t want the line! That’s it!” she refused adamantly.

“It’s a very common procedure, A lot of the patients on the ward have Foley catheters. It’s not a problem at all. Look around you.”

And as soon as I turned around to show her, I realized what a terrible mistake I had made. All around us were beds with old, chronically ill patients, hooked up to a vast assortment of IV lines and dialysis bags. Some had central lines peering incongruously out of their jugulars. Others were swollen and bloated, stepping in and out of uremic stupor as their kidneys failed to excrete the waste their bodies had accumulated. To a young girl it must have looked like death.

“You told me to stop drinking water, I did that. You told me to cut down on my salt, I did that. But I’m not going to let you insert the catheter!” she sobbed indignantly.

I finally understood. To me, a Foley’s catheter was merely an appliance I used to treat a patient’s symptoms or manage a pathology. But to Faiza, it was a violation of her body. A humiliating exercise that meant she was no longer in charge of her private functions. She didn’t want to give up her self-respect and was fighting resolutely for it.

“If I refuse to let you insert it, what will you do?” she challenged me.

“If you don’t want to have the catheter, we won’t put it in. We won't do anything you don't want us to,” I reassured her. “Here, look at this,” I said, pointing to the note in her chart where the previous resident had documented her refusal after his counseling had also failed.

“Yes, I don’t want it!” she said, seizing the chance. “And I want to go home. It’s Eid next week and I need to make new clothes. Tell the doctor I have to go home.”

Later in the day when we came over to round, the attending physician tried once more to convince her to get catheterized and he met with the same steely resistance that I and my colleague had. Faiza refused persistently and finally we decided to manage her symptoms medically and arrange for a drug to be brought over from Karachi.

As the team went ahead to the next patient, I turned back to her, unable to suppress a smile. “Mubarak ho!” I whispered congratulating her. “You won’t be getting the line after all.”

“Khair mubarak,” she said, smiling back.

4 Comments:

Blogger Anjum said...

=) good for her.
I hope she didn't get the infection since she didn't have the catheter.

Thanks for doing another med story. Did you not realize you had amazing blogging material right in front of you (at your job)?

Eid mubarak :-)

10:52 AM  
Blogger karrvakarela said...

Khair mubarak. Thank you, I'm glad you're enjoying the stories.

About Faiza's infection: she will eventually get it if the urinary stasis persists. But, and this is good, I spoke to her afterwards, and suggested that we teach her to catheterize herself. "You mean I'll be able to do it myself?"

"Sure."

"OK."

So that's been settled.

6:10 AM  
Blogger Anjum said...

nice! good move there, allowing her to feel more in control of her situation. i have to do that too at work - not regarding catheters, but regarding client's methods and documentation.. some clients are willing to take my advice and some are holding on to the old ideas with a death grip..

8:45 AM  
Anonymous me said...

You're lovely :)

Faiza controlled her salt intake but it seems as if you rubbed it all over :D...karvahat jo chali gayi.

3:01 PM  

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