manners and mortality

Moving on now from the delicate topic of religion and faith........ (funny how this is a topic that is almost considered taboo. I see plenty of posts about peoples' sex lives, but rarely writings about spirituality. It's as if discussing religion is way more impolite than discussing favourite sexual positions. Odd.)

I spent last night tossing and turning and dreaming of giant livers, glistening and distorted. I dreamt of masked surgeons. I dreamt of the lady I saw yesterday - the lady who sobbed in my room, as I informed her that her CT scan showed a cancer growing on her liver.

To be brutally honest, I'm not sure why I am so disturbed. I have met Diane* only twice now (usually she sees another doctor at the surgery where I work). She is not someone others warm to ..... the receptionists moan about her being an 'awful woman'. As I called her in to my room yesterday, I asked her if her husband was coming in with her, and she spat out "No! I don't want him anywhere near me. He's useless." Howard sat a mere six feet away. He quickly grabbed a newspaper, and studied it fiercely.

I ushered Diane to a chair in my room, closed the door, and sat down. I told her gently and simply, "The scan shows you have a cancer growing in your liver." I passed tissues as she cried. With her permission, I called her husband in. As he tried to comfort her, she swatted his hand away and told him to 'Shut up, Howard!'.

When I have to break very bad news in my job (which, thankfully, is rare), I often feel quite emotional. I have to steel myself and blink more than usual. I am inclined to get very attached to my patients, so to tell one of my regular patients that they have a life-threatening condition always twists me up inside. But with Diane, I felt concerned yet calm. I let her cry awhile, while I stayed dry-eyed. When her sobbing abated, I quietly explained that I had made an appointment for her to see a surgeon. I passed more tissues, and answered her questions as best I could. An hour later, I drove home thinking of this unhappy, grumpy woman, who was now devastated, bewildered, terrified.

When I was younger and more self-absorbed (yes, more!), I had no affection for 'difficult' people, and outright disliked patients who were rude or irritable or demanding. I took their impolite behaviour as a personal affront. I bewailed their lack of manners; their failure to show me the appreciation and respect I felt I deserved. Why was this person so angry and annoying, when I was being so helpful and nice?! Yes, folks, I thought it was all about me.

These days, patients can still rub me up the wrong way, but I hardly ever get in a stew. It has dawned upon me that sometimes a person is 'awful' because awful things have happened to them; because they have been treated awfully by others; because they did not have the intrinsic resilience to survive what life has thrown at them. I may still find their behaviour offensive, but I don't take offence. More than that, I develop a strange sort of fondness for some of these perpetual pouters. One of my patients stridently refuses medication for her depression, continues to smoke like a chimney despite her diabetes, tells me she wishes her husband would die, and complains that I haven't helped her sleeping problem one iota. Yet she keeps coming back, and I care about her; I want the best for her. I believe I understand her.

Today, though, my thoughts keep returning to Diane. She faces a huge battle with this nasty ball of malevolence growing inside her. From what I can tell, her emotional reserves are low. Her medical history means that any surgery carries higher risks. If she survives the surgery, her fight may not be over, because the scan showed there has been spread beyond the liver. This woman who defeated another cancer, over a decade ago, now must face up to a malignancy once more. I doubt that Diane will have much support, because I suspect she has alienated many friends and family. Misery loves company, but no-one wants to come visit.

I do not know what exists beyond our lives on Earth, but just in case this is IT, I'm living my life as well as I can. I love my life. But what of Diane? What does she think of the life she has lived? Does she feel satisfied with any part of her life?

Was she frightened last night, as she lay stiffly beside the husband she shuns? I'm certain she was scared.

Scared, and utterly alone.





*As usual, names and other medical details changed to protect patient privacy