Tuesday, January 15, 2008

dancing around an elephant

One of my patients is dying. Perhaps I should clarify that - given that we all are, in essence, heading for that final curtain. One of my patients is dying, and will die soon.

I still find it disturbing and unsettling, no matter how many times I attend someone in their last months, weeks and days. Dying is such an unknown, and so brutally complete. There can be no encores - at least not in this world. I wonder how the person feels, and if they are afraid. I wonder if they wish they were well enough for just one more stroll along the sand, just one more lazy afternoon devouring a thick novel, just one more animated, wine-fuelled, late-night debate with family or friends.

I'm not sure whether it is coincidental, but my last two terminally-ill patients have seemed, to me, quite withdrawn and distant. Almost emotionless. I asked each lady how they were feeling, mood-wise. Each replied calmly that they had 'come to terms' with their situation. Yet, to me, it felt like more than 'coming to terms' - to me it seemed more like a slow 'checking out'. We discussed their wishes for their last days of life as if we were discussing a grocery list.

It was in this strange atmosphere of disconnected emotions that I visited 'Mrs E' yesterday. She lives alone in a small retirement village unit. She was sitting patiently and uncomfortably on a seat near the front door. Her arms & legs have wasted even more since I saw her last week. Her eyes and skin are turning a delicate lemon yellow. And when I felt her abdomen.... suffice it to say the distortion of her internal organs filled me with horror at the time, and brings tears to my eyes to recall it now.

We sat and talked about her discomforts, and made plans to relieve her symptoms as best we could. Arrangements for assistance in home and personal care were confirmed. I lightly stroked her swollen feet as we discussed the fluid retention - not because it would help, but because I wondered if anyone ever touches her poor puffy feet. Mrs E earnestly discussed a new medication, and mentioned troubles with her phone. And the enormous elephant, the subject of Mrs E's impending death, stood in the centre of the room. We both leaned to look around the elephant and continued to discuss nursing visits.

I know there is a cycle of life and death. I know that Mrs E is an elderly lady, and that this is the inevitable conclusion to her life. I know that she is wiser than I am, and I do believe she is accepting of the fact that she will not live to see winter. And yet her bony arms make me want to weep.


Anonymous said...

right now there are people in my life that are drawing closer to that point and I'm not sure how to react.

Heidi said...

Oh my... this is definitely part of your job I have not heard about yet from your blog. Yet, I suppose, I figured it was there.

My mom and I were just speaking today about how she feels helping out at the senior center lunch room in their community (she herself having just turned 67... she is amazing that she is the volunteer here). She said that the hardest time there is the change... mainly meaning the change in the cast of characters there. She misses them when they are gone... but does not fail to give them hugs when they are there.

mackeydoodle said...

"Dancing around an elephant"
I am not going to ever forget this term.
My Mom is a nurse in pallative care....I do not know how she does it.
People like you make such a difference Jelly.
Blessings to you.

Remiman said...

I believe that it is through these encounters that we, ourselves, "come to terms" with the inevitability of death. So when it's our turn we can pet the elephant rather than talk around him.
When my mother was being paleated in our ICU with a fentanyl drip, I'd vistit her morning and night. One morning when I stopped in before going to OR I said to her, "how ya doin' today mom?" She looked me in the eye and just as lucid as can be she said, "I'm not dead yet!" She was tired of waiting and was disappointed that "it" was taking so long.

freefalling said...

It's hard to gather all the different thoughts I have when I read your post, and put them into a succinct comment.
Of course, I can't.
I have written several sentences and deleted them all.
It's like it is so big I can't gather it all in.
But I so appreciate that you have shared this part of you with us.

John Cowart said...

My guess is that you touched more than her feet; you are touching her heart.

Sandy said...

I've written & rewritten my comment here and just can't seem to say what I feel here in words. Many of my husbands siblings are much closer to the ends of their lives than I care to think about and it's very sad.

You are a good & caring doctor Jelly and you really do make a difference in your patient's lives...you know how to reach their hearts.

shellyC said...

The lesson here is to live life to the full! So that when we get to the point of "Dancing around the Elephant" - we will not feel the need for another walk along the beach, a wine fuelled night with friends and the chance to read another great novel. We will have had more than our share of wonderful walks, wines and books.

meggie said...

What a compassionate person you are Jelly.
I was discussing my friend the Bride's death with my GP today. She had been the Bride's Dr too. We both agreed, it had been a blessing when she went, but seemed so sad, because she was so alert & vital mentally.

thisisme said...

Jelly, there is so much I want to say, but I don't know the words. Thank you for such a beautiful, sombre post.

Susan said...

A good doctor is so hard to find. You make house calls, you rub feet, you actually care for your patients. Healthcare is such a 'business' anymore, all about the $ (at least here in the states), it is refreshing to hear your take on it.

Job well done, jelly!

Kerri said...

It's so encouraging to read your thoughts Jelly. It makes me realize there are doctors out who don't just think of patients as numbers or 'their job'.
I hope in my old age I'm lucky enough to have a Dr. who cares, and realizes the importance of touch, etc.
A sweet post from a sweet doctor. Thanks Jellyfish....er, I mean Jellyhead :)

Redneck Mommy said...

I like to think of death as just a door way to something new. It's just so often an ugly ride getting there.

Heather said...

This is the hardest part of what we do, isn't it?

I once terminally extubated a forty-something year old man who had anoxic brain injury and his mother fainted.

My heart went out to her and I wanted so badly to make it so that her son's imminent death was not her reality. But I couldn't.

And it was very sad.

fifi said...

oh, I could barely read this when you first posted it.

I have thought about it, and keep returning to the fact that it is affirming that you exist, in the role you have, and in the world.

I always try to live in a present which acknowledges that each day is a gift.

Mimi said...

How miserably sad. I wish I could visit Mrs. E. just to give her a hug and talk to her. Both of my parents have died and I was with both in their last weeks, days, hours and minutes. My mom died peacefully and unafraid in my bed with her whole family, including all the kids, surrounding her. It may sound strange but it was beautiful. Watching both my parents take their last breath was life changing. I do not understand anything more about death but that it is intricately connected with life. Thank you for sharing this important post.