It began as mild pain during the passing of urine. Grandfather did not speak up. It progressed to frequent pain and stiffness in the lower back and pelvic area. He reached out to his NOKIA 3310 and dialed his eldest son’s number.
“I am having a lot of pain son. Come and have me visit a doctor.”
“Where is the pain papa?”
“From my waist downwards and a bit of back pain”
“Will be there first thing tomorrow.”
“Thanks, son. Remember to come with that sweet thick milk that is red.”
“Is that what it is called? If so, yes.”
The conversation ended with a hearty laugh from both father and son.
The journey to the countryside is approximately 5 hours drive. By 4 a.m., my father set off to have his father see a doctor for the pain he had. It is always glad for a father and son to meet and catch up. At the time, the old man was 80. My father was 40. The doctor made his diagnosis and established that the bones of the old man were fragile and any strains in the recent past must have led to such excruciating pain. He was treated to a few pain killers and some mild physiotherapy sessions. He felt perfect and set back to his routine of solving minor cases of his grandchildren and having evening strolls in the village.
Two months down the line, the pains reverberated fourfold. This time, it was accompanied by a frequent urge to urinate. Occasionally, there were traces of blood in the urine. There was also an intense burning sensation during urination. Grandfather made another call. He was taken to the hospital and for a second time, there was a misdiagnosis. He was treated for a bacterial urinary tract infection. In a way, the symptoms vanished but only for two weeks.
When grandfather made the third call, his voice was frail. He sounded desperate. My father, his son, knew all was not well. He needed a thorough diagnosis. In a day, he was brought from the village to Kijabe hospital. At Kijabe, the diagnosed him with prostate cancer stage III. Prostate-Specific Antigens (PSA) was high. There was a large growing tumor in the groin region. All these were indicative of locally advanced cancer that was likely to grow and spread. He spent a week at the hospital and did not get any better despite the necessary remedies. He was referred to Kenyatta National Hospital.
At the referral hospital, further biopsy tests revealed that cancer had spread beyond the prostate. It was damning news for all of us. Grandfather however was not informed. Doctors advised that it is important he was told. Nobody had mastered the courage to inform him that he was diagnosed with stage four cancer. The best that was done by the doctor was that he was told he had a male ailment for the aged that affects the male reproductive system.
It was at that moment that it dawned on us that it is never easy to break the sad news to a member of the family. The denial and fear that comes with it are untold. Numerous study results however indicate that patients generally desire frank and empathetic disclosure of a terminal diagnosis or any other bad news.
According to an American Family Physician website, the best way to go about it is embedded in the mnemonics ABCDE:
Advance preparation—arrange an adequate time and privacy, confirm medical facts, review relevant clinical data, and emotionally prepare for the encounter.
Building a therapeutic relationship—identify patient preferences regarding the disclosure of bad news.
Communicating well—determine the patient’s knowledge and understanding of the situation, proceed at the patient’s pace, avoid medical jargon or euphemisms, allow for silence and tears, and answer questions.
Dealing with patient reactions—assess and respond to emotional reactions and empathize with the patient.
Encouraging/validating emotions—offer realistic hope based on the patient’s goals and deal with your own needs.
When we finally told grandfather, he stared into the environment for twenty minutes or so, without a word. He then broke the silence.
“How long do I have to live?”
Again, nobody was prepared to answer that question. Considering that we had to offer realistic hope, he had a few months to live.
“The doctor has assured us that they will do everything within their abilities to keep you with us, but cancer has spread quite a bit and we must cling onto any hope we have.”
“I am not afraid to die. I just need to know how soon. I desire that I die on my farm.”
A multitude of us began shedding tears. The old man was ready for death. Not many are ready.
We began a series of alternate visits to the hospital to check on him and give him all the assurance and anything he needed. When he began using a catheter to pass urine, we knew it was the beginning of the end. His voice faded day by day. He was unable to do anything on his own.
Watching someone slowly lose their life is one of the hardest human experiences that live with you forever.
That fateful day he breathed his last, we were weakened to the core. Death is something one never comes to terms with. It cannot be well received no matter how much we had foreseen it. But life keeps going on with its cycle.
“In three words I can sum up everything I’ve learned about life: it goes on.”
― Robert Frost