just one more unit of blood?

I’ve been involved in looking after a lady with cancer of the cervix that is so advanced that there is no treatment for her now except transfusions to replace the blood she is constantly losing. Her Hb came back as 4, dangerously low, and when I got to her bedside she was an awful shade of grey. She hardly flinched when I shoved a great big cannula in her vein so we could get IV fluids into her and buy her some time. The student explained to me that her guardians could not donate blood for her and there were no stocks in the lab either, I thought this would mean she had a rare blood type but it wasn’t, it was 0 +ve, just like me.

I knew I couldn’t just walk away, so I wiggled out of the meeting I was meant to go to and went to the lab instead. They thought I’d come to give them a hard time about not having blood for her and nearly fell over backwards when I said I wanted to donate some instead. They tested me (free HIV test, Hepatitis and STI screen – TVM…) and with everything coming back ok, they shoved a great big needle into my vein and siphoned off a unit. It didn’t take long but I didn’t hang around to actually see my still-warm blood drip into her, that would have been a bit weird, but at least she survived the night and when I went to her the next morning she looked a smidge better, but so, so tired.
The concept of palliative care here is quite alien and trying to get the students to understand it let alone explaining it to a patient using a translator is hard. I spent a long time with her though, gently getting round to saying that without more blood her ‘body would fail’ and she would die. I just didn’t know if it had sunk in but later she spoke to the student and asked if she could be discharged. She’d timed her decision with lunchtime though which usually means that everyone scarpers quick time but I managed to find two doctors in quick succession that agreed she could go. The paperwork was filled in and I went to see her one last time, I held her hand and said goodbye, tears welling in my eyes and hers, I wish I could have said something more but everything I thought of just didn’t seem right – what do you say to someone that is being sent home to die?