Case Outline
The Patient
Farhad Tabrizi, a 69-year-old immigrant from Iran, is brought tothe emergency room at St. Vincent’s Hospital Dublin Ireland, aftercoughing up blood. He presents with severe coughing, fatigue, chestpain, shortness of breath, and headaches. After stabilizing Mr.Tabrizi, the emergency room team admits him to the hospital, wherehe is given (over the course of a few days) a thorough workup,including chest x-rays, CT scans, mediastinascopy, and a PETscan.
After admission, the attending physician Dr Looke attempts togather a detailed health history; but this proves difficult, sinceMr. Tabrizi speaks almost no English. He does speak fluent Farsi,but there are no Farsi-speaking medical personnel readilyavailable. However, Mr. Tabrizi is accompanied on-and-off by hisadult son, who is reasonably fluent in both English and Farsi. Heis also accompanied intermittently by his wife, who speaks onlyFarsi. The nurses attempt to gather a health history whenever theson is present, which is not always easy, since his visits areunpredictable. Even when his son is present to help translate, Mr.Tabrizi seems extremely uncomfortable offering up any detailedinformation about his own or his family’s health history, causinghigh levels of frustration among the medical staff.
Additionally, Mr. Tabrizi appears extremely reluctant to eatwhatever food is offered him in the hospital. This is mostpronounced when he is alone-if neither his son nor his wife ispresent at a mealtime. On the second day of his stay, his sonexplains to the flustered nurses that Mr. Tabrizi is fearful thatthe hospital food may contain hidden pork by-products. Since he isa devout Muslim, he feels it is safest to refuse the foodaltogether unless he is absolutely certain. Although the son hasattempted to persuade Mr. Tabrizi that he (as a sick person) musteat, Mr. Tabrizi apparently is determined to eat as little aspossible. The chief nurse curtly replies that, while religiousbelief is important, Mr. Tabrizi needs to keep his strength up ifhe hopes ever to go home; thus he will need to nourish himself byeating more. She says that she will “see what we can do” aboutensuring that there is no pork used in the hospital’s foodpreparation. The son thanks her for her help. From then on he andhis mother attempt to bring outside food to Mr. Tabrizi wheneverthey visit.
After almost three days in the hospital, the results of thevarious scans are in; and the attending physician, Dr. Looke, sitsdown with Mr. Tabrizi to discuss his situation. His son and wifeare also present. Dr. Looke first offers a handshake to Mr.Tabrizi’s son. He inquires explicitly about the extent of hisEnglish skills and asks if the son would be willing to translatewhat he is about to say to Mr. Tabrizi. He agrees, while Mr.Tabrizi and his wife sit by. The doctor then gazes directly intoMr. Tabrizi’s eyes and tells him that he has extensive small celllung cancer.
After a moment of stunned silence, the son turns to his fatherand tells him in Farsi that the doctor believes that he is verysick, with some “growths” in his body. Dr. Looke goes on to saythat Mr. Tabrizi most likely does not have long to live. The doctorholds up two fingers (at which point the patient grows increasinglyalarmed and agitated), describing that there are basically “twopossible treatments” available for this cancer: chemotherapy andradiation; Dr. Looke strongly prefers beginning with the first(chemotherapy). In spite of Mr. Tabrizi’s alarm and confusedexpression, the doctor presses on that, given the apparentlyadvanced stage of the disease, even chemotherapy would be veryunlikely to provide a complete cure, but it could provide somerelief and lengthen the remainder of his life. The son, againsilent for several moments, then turns to his father and also holdsup two fingers. He tells him that the doctor says he must do twothings to care for himself: eat well and get more rest. He alsorelays that his father could take some “strong medicines” whichwould most likely help him to get better. Mr. Tabrizi looksextremely uncomfortable but says nothing.
After a few more moments, Mr. Tabrizi, somewhat confused, asks(via his son) what the “strong medicines” would consist of. Thedoctor replies by describing (in some detail) what the course ofchemotherapy would look like-how often it would be administered andthat the treatments would last for several weeks. He also describesthat it may produce severe side effects such as nausea, vomiting,increased fatigue, and elevated risk of infection. In spite of hishesitations, the son attempts to translate the bare outlines ofthis information (leaving out the term “chemotherapy”), at whichpoint Mr. Tabrizi declares flat-out that he doesn’t want any suchcumbersome treatments; they would compromise his relationships withhis family and friends and place too heavy a burden on his wife.Further, he doesn’t really know what might be in such a strongmedication that could help him get better. Instead, he will simplydo the two things the doctor had recommended-improve his diet andget more rest.
The Doctor
Dr Looke has been working at St Vincent’s hospital for someyears now. His workload is high and he often works 24 hour shifts,as a result he is frequently tired and feels burnt out. He has metwith Mr Tabrizi on several occasions but is unhappy with theprogress in this case. He is patient when communicating with thePatient via his son and simplifies his speech and tries to explainthrough images and drawings to help his patient and familyunderstand. He reflects on his patient interactions to help himselfcontinually improve. He believes that the patient has the right toknow all information about their condition, treatment andprognosis. However in this case Dr Looke has not had access to aFarsi translator as it not one of the most common languages thishospital often deals with and therefore reluctantly, Dr Looke isrelying on the patient’s son to aid in translation. Dr Lookehowever does not feel confident that he has established arelationship of clear open communication and trust with his patientand his family. He has done what he can to communicate his views tothe patient’s son. The patient’s son appears to understand thesituation yet Mr Tabrizi is reluctance to engage with the treatmentand this somewhat of a puzzle to Dr Looke.
The Family
Mr Tabrizi’s wife visits him as often as she can and makes it apoint of regularly offering prayers for her husband’s health. Sheis very worried about him and she does not clearly understand whyhe is ill or what the treatment options on offer are. Also thisfamily do not have private health insurance and she is concernedabout the hospital costs. Mrs Tabrizi works part-time in a clothesalternation service and find it very difficult to work, take careof her family and visit her husband in hospital therefore shecannot attend often nor be there when her son is free to visit. Theworry is affecting her health also; she hasn’t been sleeping welland is suffering from exhaustion.
Mr Tabrizi’s son is also very worried about his father. He feelsit is his duty to protect his father and mother from further worryand stress and is trying to “soften” the news and explain it inways he feels his father will be able to cope with. He loves hisfather dearly and wants protect him from unnecessary stress, whichhe believes may hamper his recovery at all costs. Mr Tabrizi’s sonis new to Dublin also and works in a very demanding stressful job,he is trying to improve his English while working and also workslong irregular hours. He is not at all familiar with the Irishhealth system and is not clear on the options for patients in thepublic health system or how it works. He does not feel confidentasking Dr Looke about these matters. He is very worried and anxiousalso with this situation, feeling the full burden of being theeldest in his family and therefore the one to take responsibilityfor all of this.
1-Discuss why altruism and compassion are important componentsin the provision of care for this patient.
2-Drawing on this case study as an example, what are somepositive and negative consequences related to altruistic andcompassionate behaviour?
