The ECG shows a major heart attack. It is necessary to act quickly, because the urgency was still unclear upon arrival at the emergency department. The nurse transfers: a man, well into his nineties, no previous history, where the nurse at home noticed that he is breathing rapidly. Here he is still breathing quickly, but he does not feel any complaints.

Does he need an angioplasty? They only do that in larger hospitals. I call the cardiologist, but he doesn’t need to see him: the heart enzymes show that the heart attack is older. Absorption, fluid through the IV and blood thinners. We’ll look further tomorrow.

A volley of care is deployed. The radiology technician takes the chest photos, the pharmacist checks his medication and the bed coordinator looks for a place in the hospital.

I can tell from his acidic blood that his heart attack is serious. The muscles become acidic because the heart can no longer pump blood properly. When I tell him about the diagnosis and treatment, he throws up his shield: he refuses to take the medication. He is already in his nineties, has never been on medication and does not feel like starting it now.

His refusal makes me relax. Now nothing is necessary anymore. It is noticeable that he is alone here, I ask him about his loved ones. He never had a partner or children, and all his friends from the past have died. For years he has not been able to get further than the hall of his assisted living apartment and has hardly left his room for weeks. He says he grew up in bombed Rotterdam, worked as a chef, and traveled to Southeast Asia.

I like to listen, but as a doctor you also have to stick to the point. “You will probably die in the next few days without medication. The body is already acidic, and the process of acidification will continue until you are exhausted and the body can no longer cope. Here in the hospital we can monitor you and provide comfort.” He is silent for a moment. But he continues to refuse medication.

“What do you want? If you do not want to be treated, you do not have to stay in the hospital. Then you can also go home, with intensified home care. Or we can try to arrange a hospice at short notice.” He does not know.

Meanwhile, his hands and feet are starting to get colder, his pulse weaker. New blood tests show that he is becoming more acidic. “Would you have wanted to be admitted to the hospital?” Silence.

We decide to keep him in the hospital. An hour later, my shift is almost over, the nurse who has to pick up the patient from the ward comes running towards us. The patient is dying.

A laurel wreath of healthcare workers gathers around him.

After the inspection I call the GP from his file to tell him that his patient has died. It turns out to be an old general practitioner. It is unclear who his new doctor was. Then I try the first contact. The number is not in use.

I listen to it on the way home Abbot Agathon by Arvo Part. The soprano sings the story of a leper who is helped by the Abbot Agathon. Agathon does as the leper asks him: he carries him to the market, buys him pastries, and then returns him to the place where he found him. The leper turns out to be an angel, who blesses Agathon for his mercy.

Someone should have asked my leper if he wanted to be carried to the market.

Dino Gacevic works as an ANIOS in the emergency room. He temporarily replaces Karin Amatmoekrim in this position.


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