ASLEEP

"Al", thirty-five, suffers from lymphoma that has spread throughout his body. Al lives with his wife and two young daughters in a two story townhouse. There are no bedrooms downstairs and Al spends his days sitting on the living room couch. He can no longer manage the stairs and is using the couch as his bed. He has refused a hospital bed and is content to stay on the couch.

Al has rapidly declined this past week. I made a visit today to see him and he looked jaundiced, pale and weak. He was sitting up so straight on the couch. When speaking with him, his eyes would glaze over and his eyelids would start to droop. He had difficulty focusing because he was so tired.

Several times Al fell asleep sitting up. He would jolt himself awake and open his eyes wide to prevent himself from falling back to sleep. He would slap his cheek to keep himself awake. Al's parents were present and caring for him while his wife was out running errands. Al's parents speak only Cantonese, but one could see from their body language; anguish and grief.

I encouraged Al to lie down and take a nap. He said he wanted to stay awake as his parents and wife feared that if he fell asleep, he would not wake up. I encouraged Al to tell his parents that sleep does not cause death. Sleep is the natural progression of the disease as his body needs rest to fight the cancer.

Al could not focus enough to translate the information to his parents. Whereas in the past, it worked well to have him translate. In hospice we always offer to have an interpreter, and at each offer, Al stated that he could translate.

I asked Al if I could return in two days with an interpreter in order to speak with his wife and parents about disease progression and expectations. Al was receptive to that idea.

I have arranged for an interpreter to accompany me for my next visit in two days. Hopefully I will be able to offer support and clarify disease progression with the family. Also I hope to learn and understand their cultural beliefs and support that as well.


ASLEEP

He fights to stay awake.
He does not want to fall asleep.
His eyes shroud over and slowly droop.
He needs to get some rest.

His family fears he won't wake up
if he closes his eyes or lays down his head.
They believe sleep will cause his death.
They just don't want him to die.

He slaps his cheek to keep awake
when he feels the pressure to doze.
He won't lay down, but sits up straight.
He strives to not disappointment them.

He speaks some English; his family does not.
Communicatiopn has been slow.
But now he can no longer translate for us.
The disease has robbed him of precious strength.

He told me that he wants it over.
He's tired of the fight.
But he'll continue to honor his family,
until he falls asleep.