As a young child, M grew to accept the odd little lumps and bumps which grew on his chest. They didn’t hurt or get in the way of his daily activities, so he didn’t complain and simply got on with life. He was an active child, friendly and outgoing, a good student and a good sportsman.
As M grew older, more and more lumps and bumps appeared on his chest, and the existing ones from childhood grew larger. Still, they didn’t hurt or get in the way of his busy daily life as a working husband and father, so he didn’t complain. M worked hard to provide for his young family, and took great pride in raising his children to be as well educated, well mannered, and industrious as their father was.
In 2011, financial circumstances forced M to leave his home country of Nigeria for South Africa, to seek better financial prospects for his family. In Nigeria, extended families take responsibility for each other, with the most senior, respected member of the family (in this case, M’s mother) assuming responsibility and providing guidance both emotionally and financially. This meant that M could leave his wife and children knowing that they were well cared for in his absence.
With his polite, helpful, diligent nature, M soon became successful in South Africa with his home-run business of making burglar guards for people’s homes. He was able to send substantial amounts of money home regularly, although he himself led a fairly frugal life, often helping out neighbors and his community instead of spending on himself. He led a modest and devout life, working hard and giving generously – a proud man who was well loved and respected in the community.
During 2015, the lumps and bumps on M’s chest became very enlarged and painful. In constant pain, struggling to breathe, and unable to bend his arms, M was unable to continue working. He moved into a small shack in a friend’s back yard, and had to depend on his landlord and neighbors for food and a roof over his head. Being the proud, independent, self-sufficient man he was, this was very difficult for M to accept. He could no longer provide for his family back in Nigeria, and worst of all, his health continued to deteriorate. He could not understand what was wrong with him – if only he could have these lumps and bumps cut off, he would feel strong again and be able to work again.
It was not to be however. M was hospitalized in 2016 and a biopsy of his lumps and bumps was done. They turned out to be cancerous. M’s hampered breathing, agonising pain, and swelling and odour from the nodules were actually symptoms of Sarcoma of the Chest Wall. This is a form of chest wall bone cancer, in which cancerous tumours develop in the chest cavity (the cage of bone and muscle that holds the lungs, heart and other vital organs).
Although the hospital did a biopsy to diagnose the disease, they did not inform M of the outcome. Instead they referred him to Helderberg Hospice and sent him home. He was now 38 years old.
M was admitted into the In Patient Unit at Helderberg Hospice on a Wednesday, hoping to hear that the lumps and bumps could be removed, and he could continue working again. As ill as he was, his goal was to work again so that he could become independent and provide for his family back home.
We at Helderberg Hospice have an interdisciplinary approach, which means that not only did our In Patient doctor and medical staff get involved with M’s case, so did our social workers and Home Care staff. We quickly realised that M did not know the severity of his disease, and was unaware of the implications thereof, ie, that he did not have long to live.
Our Doctor sat down with M and had a man to man talk with him, explaining clearly the extent of his disease and its life limiting effects. After the talk, this gentle, proud, humble man asked politely to be left alone. He withdrew into himself, a mass of emotions and conflict. Over the days that followed, staff continued to be caring and supportive, gently reminding M that they were there if he needed them.
M was encouraged to talk about his questions, to discuss his fears and concerns, and gradually he opened up, becoming more comfortable with the staff, and allowing them to comfort and support him. He let go of the hope of medical treatment and accepted that he needed palliative care, which focuses solely on comfort and quality of life in the time remaining to him. Despite his reservations over his physical appearance and odour, he even allowed staff to hug and embrace him, seeking the reassurance and warmth of their caring touch.
During the period when M withdrew into himself, the most amazing thing happened. He let go of the hope of further medical treatment, and thought about the meaning of his life, his beliefs and what would comfort him most as death approached. What was of most importance to him, and what would bring him absolute peace, was to spend his last days with his family in Nigeria.
Our interdisciplinary team, comprising of our CEO and Management, IPU Doctors, Nursing Services Management, IPU Ward Sisters, Social Workers, and Home Care Sisters, meet twice a week to discuss each patients needs in detail. In consultation with M, the options available to him were examined, and a plan of action agreed upon. M would go to a care facility for the terminally ill for six weeks, whilst our social workers looked for a way for him to return to Nigeria.
Our Social Workers looked for any next of kin here in South Africa, and during this process, realized how well loved M was within his community. His Landlady had taken care of him whilst he was ill and still living in their back yard, and many neighbors had joined forces to feed and clothe him whilst he was unable to work. It turned out that M had a cousin in Johannesburg, who could not assist himself, but did give us the contact number of a Pastor in the Grabouw area who knew M well. With all these caring people working together to find a solution, the Pastor approached M’s family in Nigeria and asked them for help. The following day, M’s mother had booked him a flight home! Our Social Workers explained the care that M would need as his disease progresses, and happy that he would receive the care and support he needed, discharged him a few days later.
Such is our commitment to the care and well-being of our patients, that one of our Sisters accompanied M to collect his few belongings, and then to the airport to say goodbye. For M, going home to his family is a dream come true. Nestled in the loving arms of his relatives, he is at peace with his coming death, humble and grateful for the time he has left with what is most important to him – his family.