Ascites (Huh?)

Occasionally, a nurse at the weekly hospice team meeting will give an incomplete report about a patient. The team leader may prompt the nurse to make sure all the basics are covered. Though my medical knowledge is limited (and that’s a generous assessment), I’ve gone to enough meetings to anticipate a few of the predictable questions . . .

  • Does the patient need oxygen? Is it continuous or as needed?
  • Is he bedbound?
  • What is her F.A.S.T. score?

In recent weeks, because of several patients’ situations, I’ve added another query I could ask if a nurse forgot to include the information in her overview.

  • Any sign of ascites?

Huh? First, let’s get to the simple, safe stuff . . . ascites is pronounced uh-site-eez.

And then there’s not-so-simple, unsettling definition: “When fluid builds up inside the abdomen, it is known as ascites. Ascites usually occurs when the liver stops working properly. Fluid fills the space between the lining of the abdomen and the organs.”

When the “fluid builds up,” that means the stomach area can look huge . . . distended. It won’t appear to be the flabby “beer belly,” but often a balloon near bursting. There’s nothing nice about it, and nearly everything that may produce ascites is far south of unpleasant:  from the likely blood-borne virus hepatitis C, through the predictable cirrhosis of the liver (which can happen with too much alcohol consumption and can also happen when booze has nothing to do with it), to the less frequent but grim pancreatic cancer. The potential causes for ascites are many, and all are nasty.

How could a nurse “forget” to add ascites to a patient’s list of ailments? Well, we all forget things. But even more, ascites indicates that something worse is going on. The hospice medical team will likely be more concerned with the cirrhosis or pancreatic cancer. And maybe also a nurse neglects to mention ascites because it’s obvious and inevitable.

As awful as ascites is—and it is—it can’t help but be noticed. No patient can persuade a nurse to believe . . . “There’s nothing wrong with me other than I overate a little.” Or . . . “Easily gaining weight runs in my family.” Or . . . “I shouldn’t have had that second piece of pie.” No excuse or rationalization will work. Ascites is as obvious as the green, yellow and red of a traffic signal.

How easy it can be to disguise emotional or spiritual pain . . .

How easy it can be to disguise emotional or spiritual pain . . .

I wish the “non-medical” ailments were as obvious, and had telling side effects.

I wish that, when patients grappled with a terminal illness, their fears and doubts would produce a variation of a “fluid build up.” And so, when a chaplain or social worker asked patients how they were doing, they wouldn’t play catch-me-if-you-can with their hurts, or make excuses or rationalizations. How easy it can be to disguise emotional or spiritual pain.

I wish that, when loved ones grieved the death of a parent or spouse, their fears and doubts would produce a variation of a “fluid build up.” And so, when a counselor or bereavement specialist asked the grieving ones how they were doing, they wouldn’t play hide-and-seek with their responses. How easy it can be to downplay our emotional or spiritual anguish.

Of course, I wouldn’t wish the worst on anyone. But the worst does happen. And honestly sharing questions and feelings with others may help reduce some of the seen and unseen pain.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

Beach image from here.

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