End of Life

Dying is an aspect of Medicine that has long been neglected in Nigeria. In its place, we are taught palliative care: how to alleviate a person’s pain and suffering, but never how to address a dying patient’s personal and social needs. This duty is made even more herculean when religion is factored into the equation. […]

Dying is an aspect of Medicine that has long been neglected in Nigeria. In its place, we are taught palliative care: how to alleviate a person’s pain and suffering, but never how to address a dying patient’s personal and social needs. This duty is made even more herculean when religion is factored into the equation. Regarding death, both Nigerian Christians and Muslims agree to deny it outrightly. So even though death is a rite of passage that all humans must go through, cries of “I reject it”, “It is not my portion”, “Allah ya kiyaye!” are often thrown carelessly, as if in death itself, is a crime.

It is human to cling to life, to want to make the best of our last years, but it seems Nigerians have a special love for this life and a deep hatred for the concept of death. A man can be 95 years old, visually and hearing impaired, but when a diagnosis of terminal pancreatic cancer is pronounced- he and his family members go into panic mode. Suddenly, they are running to India, Dubai or UK for miraculous treatment that is yet to be documented in medical journals. In this regard, Caucasians, I dare say, have more faith than us.

Mr Ibrahim* had been my patient for a very long time. He was a 45-year-old Air Force officer with one wife and 4 young children. He was regularly seen for his Diabetes until the day he presented with vague abdominal pain. I examined him and asked to carry out some tests. I also gave him some medication. As with, most patients, when his symptoms subsided, he relaxed and did not bother with the tests. That is, until that fateful day.

He claimed to have been sleeping when he felt pangs of pain in the right side of his abdomen. He woke up sweating and took some painkillers which did nothing to alleviate the pain. In the morning, he had rushed to do the ultrasound scan I ordered and came to me with the result. The radiologist report was straightforward: Ibrahim had a tumour in his right kidney.

Breaking bad news is an aspect of practice that most family physicians are conversant with; I was able to tell him in neutral tones about the diagnosis and all tests we needed to do for confirmation and to determine the extent of the disease. I was quite hopeful and told him so. His bravery as a military man was apparent as he listened to me and asked questions about the condition. A CT scan was ordered along with other investigations. I urged him to discuss with his wife so that he wouldn’t have to bear the burden alone.

He returned two days later, a changed man. Gone was the jovial and smart officer. His complexion was ashen and it appeared he had not shaved in days. His wife, who accompanied him looked grim, angry even. The tests showed that he most likely had kidney cancer and worse yet, had spread to the lungs. The urologists could not take him for surgery. Our best bet was- chemotherapy with palliative radiotherapy. He broke down in tears. His wife, however, was having none of it. I recognised the denial stage of grief as she shouted and rained curses on me. Finally, she said they would go for a second opinion. I gladly obliged; let someone else take the burden.

Months later, one rainy afternoon, he came into my consulting room unannounced. He had lost a lot of weight, with shrunken cheeks and a distended abdomen. They had travelled to Abuja and the diagnosis was confirmed at their Air Force Hospital. He had commenced chemotherapy one month ago and was not getting better. His wife insisted they travel to India for treatment. He was vomiting and tired all the time and his once smiling face had lost all its sheen. He wanted to know what his chances were.

I told him the truth. The cancer had already spread to many organs, there was nothing to be done in India or anywhere else. It was terminal.

That day, as we spent hours talking, I realised the true meaning of end-of-life care. He told me about the bank loan he had taken to buy his house in Abuja and the debt he had incurred when his wife had to undergo surgery in the States. He told me about his brothers whom he feared might not support his wife and children since she was from a different tribe and religion. He confessed his fears and together, we mapped out a plan. I advised him to get a lawyer who would draft a will and give his wife power of attorney. Financially, I asked him to try and settle all debt, so that his family would not suffer. He thanked me profusely and we parted ways.

Later, I learnt, he sold his house and bought a smaller two bedroom flat for his family. He used the money to pay off the bank loan and was even able to set up a small side business for his wife. Four months after our last meeting, his wife called to thank me for the advice I had given him.

Ibrahim had died debt free, in the arms of his family.