Sunday, March 22, 2020

"Bugle Notes" - The Couple

It was dark as we entered a crumbling stone building - a one room 15’ x 15’ structure. No electricity, no running water, no amenities, we assume “we all have”. I was leading a medical team to the poorest country in Europe, Moldova; a country I had come to know and love well. The team had finished a busy day in the clinic. Before going to dinner, I wanted to make a home visit to an elderly couple my host partner asked me to see. They were not physically able to leave their home so a few team members and I went to them.

As my eyes adjusted to the flashlight piercing the darkness, a smell permeated the single room - the stench of urine and feces. My interpreter spoke in Russian. From the darkness, came the feeble voice of a woman. It was then I saw the two elderly individuals, a husband and a wife, lying in small, separate beds against the wall. They were in their mid to late 80s, unusual for this part of the world. They were frail and emaciated, their boney hands clutching the bed covers to their chins in the coldness of the room.  He was bedridden. He could not sit up on his own.  He laid in his own excrement. How long had he been like this – days, weeks, surely not longer? His wife was not much different except that with help she could get out of bed and sit. Against the right wall was a small stone oven for heating and cooking but there was no firewood to be found. The ashes were cold. She could no longer cook. They were completely dependent upon others for help. But there were no others. They had no family. The children were either dead or lived far away trying to survive themselves. The neighbors had little to offer such was their own impoverished state. This is life in Moldova. It is hard, extremely hard, and for many, a life lived without hope of getting better.

The woman, with assistance, set up and with tears in her eyes, took my hand and thanked me over and over for coming to see her. She told me no one came to see them anymore. They were truly alone. She described the heartbreak of not being able to care for her husband. She kissed my hand and thanked me again, the tears now streaming down her face. We all cried. I turned to her husband and introduced myself. The smell from him was overwhelming. When was the last time he had been out of bed, had a bath, changed clothes, clean bedding? He could not remember. The interpreter asked me to look at his backside so we carefully turn him on his side. His bedding was completely soaked in urine and smeared with feces. I was stunned by what I saw, a very large, deep, and obviously infected sacral decubitus extending to bone, the characteristic smell of Pseudomonas awakening memories of past patients. We carefully rolled him back onto the soiled bed. They offered us what little food they had. She apologized for the house not being cleaned. She cried more. My heart wept. I promised we would return the following day. As we stepped outside, the fresh air washing over us, we were speechless. What to do was say when faced with such unexpected misery, suffering? Words were not adequate to describe what we had just seen and experience.

The next morning, the sunlight streaming through the window, the scene before us was worse than we remembered. The couple reached out to us, weeping with joy, never imagining that we would return as promised. Then began the hard work! Everything and everyone was moved out of the house into the sun. Some team members cared for the couple, stripping away their ragged, dirty clothes and began the long process of bathing them. A service of love followed as the husband and the wife with loving care were washed until their emaciated bodies were finally clean. However, the decubitus was another problem.  It was clean and dressed it as best possible. It was all we could do. In his world, there were no other options.

The house was scrubbed on hands and knees, stripping away the human waste and caked mud that covered the floor and even along the walls next to the beds. One of my most vivid memories was that of my 16 year old niece scrubbing the floor wanting to do whatever she could to help. New clothing, mattresses, pillows, sheets, blankets were purchased. Every necessity we could think of provided. After six hours of work, they were carried back into their “new home”. They wept openly when they saw all we had done. We all held hands, prayed, and cried together.

I promised we would be back at the end of the day to check on them. We returned as darkness fell and were warmly greeted by them. Once again, though, the first thing we noticed was the smell of fresh urine. He had wet his new bedding and clothes. Of course, how could we expect otherwise? Yet, they were so grateful, so appreciative. They even tried to give us a gift from their meager possessions to thank us. We told them that they had already given us the best gift of all, the opportunity to love and serve them. In doing so we hoped that we had also brought them a small glimpse of love, kindness, and hope, something they had not had - in years?

A profound sadness came over me. How terrible was their life! The reality is that much of the world lives like this - desperate, hopeless, and often alone. To live without hope is not to live at all. To be alone without friends or family would be even worse. I know what it feels like to feel hopeless, joyless, with no expectation of things ever getting better. It leads to despair, which is painful in a way that is hard to describe unless you have been there. But loneliness, I have never truly experience that. What would it be like to be both hopeless and alone? The reality is many people live like this. Patients often come to their physicians in deep despair. I read a recent article about how loneliness in the US is on the rise along with the emotional, spiritual, and physical costs associate with it. Physicians, surprisingly (or are we surprised?) score high in loneliness.

Loneliness, hopelessness, they are all around us, yet we are missing it! How many times have I missed it because I did not take the time to find out more about the patient I was seeing? How many times have you? There’s much more to medicine than just the clinical side. Equally as important, is the human side. This is where the “Art of Medicine” occurs. This is where you are needed the most. Let’s not miss it!

Andy Lamb, MD

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