One last time.

I told a man he was dying today.  He wasn’t old.  His life had been written for him by his parents and his circumstances, and as we sat there, in his room, in a nursing home, even though he was too young and too cognitively intact for a nursing home, I watched the sun filtering in the window and I wondered why.

How did I come to be sitting here, and him there?  How had I been born to two parents who in spite of their mistakes, didn’t put me in danger, kept me safe, and warm and fed?  How had he been born into the opposite?  What had happened to his parents?

When I told him, he nodded, announced he was tired, then told me I should have worn more makeup to deliver news like that.  It was no surprise to him.  We both had a chuckle.  His writing had been on the wall for a while, and today, more than he was out of time, he was out of fight.  “No hospital” he told me, when I offered a last-ditch attempt to turn things around, “no more”.  I helped him into bed, he intermittently shouted at me, followed by intermittent sheepish silence.  We talked about palliative care, he signed the form with his wishes, not for transfer to hospital, call his social worker when he died, he wanted a funeral in a big church.

I wanted to hear everything.  I wanted to hear all his stories.  Why his bedroom was decorated the way it was.  Who he’d been.  There was no time.  Earlier in the week when I’d met him, he didn’t know me, he shouted at me for the entire visit.  I tried everything I could to try and turn the ship around, but decades of hard living, multiple diseases all conspiring against us, won against my feeble attempts.  When I discussed him with my consultant, she gently suggested it was his time.  There’s always a part of me that wants to fight and she saw this, she let me try.  When I saw him again today it was on his face and in my heart.

I’ve never told a person they were dying before.  On a normal ward job, by the time they get to you, they’re unable to talk or they’re already gone and you’re having that discussion with devastated family.  Today was a long and private discussion, met by my patient with quiet acceptance, with courage, and with peace, in spite of his young age.  There was a both a stillness and a rawness in our words, he was not the sort you could mince words and I’m not the kind to try.

At the time I was focused on making sure he would be comfortable and not be taken into a hospital system that at his stage, would do more harm than good.  We planned a goodbye party.  The chaplain brought him fruit.  Afterwards the nurse and I got in the car and drove to our next appointment.  And it wasn’t for a long time later that the seriousness, the specialness, and the immense privilege of that discussion hit me.

I feel both sad for my patient and happy to know him if only briefly,  immensely humbled to be a part of his final journey, overawed at his bravery and courage in facing it the way he does.  This is why I did medicine.

Something happens to you in medical school.  You forget about why you did it in the first place, you forget you wanted to help people.  You get stunned by bright lights, start trying for the impressive specialties, ditch the touchy-feely stuff in case people don’t think you’re serious about the scientific side of medicine.  You use all the jargon, no lay terms, you pride yourself on it, you assume that those who prioritise caring over the science of it must be covering for their lack of knowledge.  And then if you come to your senses and return to those values, you wake up inside that dream.  When I was done chasing the bright lights and found Geriatric Medicine, I told one of my bosses from a different specialty what I had chosen.  He pursed his lips and shook his head.  ‘What a waste’ he retorted.  I looked him squarely in the eye and loudly disagreed.  I wanted my resident to hear how wrong he was.

When I left my patient today, I said I’d see him again next week.  “If I’m still alive!” he shouted with the sort of cheer that is half joking and half sad.  He is why I did medicine.  I am humbled and rewarded to be his doctor, even for just a few days of his life.

At the end of the day, our team went through our list of patients.  Someone announced he was now discharged from our service, he’d been referred onto our palliative care colleagues.

“He’s not discharged yet” I said out of nowhere.  It’s my first week in this job by the way.   “I can’t.  Not yet.  I need to see him one more time next week, I need to make sure he’s comfortable”.

There is silence.

“So do I” says one of my nursing colleagues.

“Me too” says another.

We keep him on our list so we can see him just once more, and try to help just one last time.

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