Ascites and Other Less Obvious Ailments

How easy it can be to downplay our emotional or spiritual anguish.

Occasionally, a nurse at the hospice team meeting will give an incomplete report about a patient. The team leader will 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 the meetings long enough to ask a few of the predictable questions . . .

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

Because of situations with several recent patients, I’ve added another subject to 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-teez.

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 an immense balloon near bursting. There’s nothing nice about it, and nearly everything that may produce ascites is 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 drinking has nothing to do with it), to the infrequent 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 with ascites will convince a nurse with a line like, “There’s nothing wrong with me other than I overate a little.” Or, “Being overweight runs in my family.” Or, “I guess I shouldn’t have eaten that second piece of pie.” No excuse or rationalization will work. For medical professionals, ascites is as obvious as the green, yellow and red of a traffic signal.

I wish the “non-medical” ailments had easily observed side-effects.

I sometimes 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 a patient how she or he was doing, they wouldn’t play catch-me-if-you-can with their hurts, or make rehearsed excuses and glib rationalizations. The patient couldn’t hide the difficult memories, nor sugarcoat the troubling memories.

I sometimes wish that, when loved ones grieved the death of a beloved friend or family member, their fears and doubts would produce a variation of a “fluid build-up.” And so, when a counselor asked them how he or she was doing, they couldn’t play hide-and-seek with their responses.

For some pains, the cutting-edge medications and the scalpels wielded by the most experienced hands are meaningless.

How easy it can be to downplay our emotional or spiritual anguish.

(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.)

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