Let me attempt to sum up the contents of the last three blogs with a reassuring and in every detail true account of what, with a little help and no small measure of imagination, can be achieved. One day, we had a patient on one of our wards who first came to my notice when a colleague consultant spoke to me about her. It seemed that although her disease was definitely in remission, she was suddenly and without warning or any prior indication, threatening to default from chemotherapy altogether. It was known (given the toxicity of the treatment) that nausea and vomiting was implicated and proving to be a problem and that she was already ‘written-up’ for an appropriate anti-emetic drug in order, hopefully, to deal effectively with it.
After a brief introduction – and a much lengthier discussion with her – (during which several other significant concerns were ‘unearthed’ and which none of us knew anything about up to that moment); we decided to attempt (with the patient’s agreement of course) some very simple relaxation exercises. As luck would have it, she took to this approach like a ‘duck to water’. Indeed, it soon became possible to embark on what now are fairly well known ego-strengthening· and reinforcing techniques.
Now it so happened that this lady had over the years holidayed regularly at a little resort on the Cornish Riviera. Clearly she loved the place and was able to provide me a detailed description (together with some holiday snapshots thrown in), which I studied in some detail with preparation of an audio tape in mind. Then came the big test: first, to try out the method in a ‘dummy run’ (in which it worked like charm); and thereafter, one Tuesday afternoon, with the real thing in mind, namely chemotherapy. As it happened, I had spent most of that afternoon in our outpatient clinic. However, somewhere around 6 o’clock, with all outpatient clinics now well over, I joined other colleagues on a fairly informal evening ward round. I enquired of sister as to how the patient in question had fared; but all she would say was “Wait and see”.
We entered the small side ward and the professor inquired in his friendly manner, “Well, well, Mrs…and how is it going? He had just returned from meetings abroad and knew very little of the past day or so’s activity with her. You may imagine therefore the expression on his face – indeed on all our faces – when she responded, “I’m fine”, adding, “Actually, I have been in Cornwall most of the afternoon”. Glancing at the vomit bowl and then at the rest of us on the ward round, he gently observed, “You appear to have been rather sick during your visit”. “Oh yes”, she responded; “But only every now and then and it never seemed more serious than a kind of temporary physical sensation. I am soon able to get back to the sea and the sand”. This simple approach saw her through chemotherapy and the last I heard of the lady – admittedly a few years ago now – was that she was still experiencing a remission from her disease and, apparently, doing well on that front.
Sometimes, nausea and the actual vomiting experiences can become perniciously linked and associated with an otherwise neutral stimulus, such as a smell or even a visual cue. This we call “psychogenic” or “anticipatory” nausea and vomiting; and I intend to write and suggest a worthwhile approach to this kind of concern over the course of my next blog.