Life without Eating or Drinking

Abstract

Total Parenteral Nutrition is no longer a short-term life-saving therapy, but can now provide an alternative permanent nutritional route following loss of small bowel function. Patients placed on the regimen go through several stages during adaptation. Those who have suffered from a chronic debilitating small bowel disease and have previously undergone multiple resections with poor residual nutritional intake, adapt more readily to the regimen than those who have suffered from the combined physical and psychological trauma of sudden massive loss of bowel. The technique has been successful in maintaining one individual in the group studied in good nutritional balance outside hospital for a period of eight years (13). This has been due to combined advances in medical surgical and pharmaceutical techniques (8). Further refinement of the nutritional support system utilized is needed to reduce the duration of the feeding process with the aim of minimizing sleep interruption and resultant fatigue. In elective consideration for TPN, assessment of both personality structure and domestic environmental support is advisable, since the patient generally does not do well in an unsupportive environment with resultant complications and frequent re-hospitalization. Conjoint training of a spouse or family member is essential; and introduction to another patient who has previously adapted well is beneficial. Later, a close liaison should be established with a Home Alimentation Nurse (8-10). The psychiatrist has a potential role in advising the gastroenterologist regarding the suitability of the individual being considered for elective total parenteral nutrition. He has a more definite role in the management of the psychological disturbance, frequently observed as depression, following surgery or later, when it appears secondary to the problems imposed by an altered modus vivendi. The group poses a further special challenge to the psychiatrist due to the unavailability of the normal route of administration of psychotropic drugs when they are indicated. In addition to the attainment of a relatively normal survival of individuals who have sustained complete loss of small bowel function, TPN offers vistas for research into body nutrition requirements (11) and demands further extensive detailed psychosocial studies of this unique group of individuals.