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I'm not sure whether it is coincidental, but my last two terminally-ill patients have seemed, to me, quite withdrawn and distant.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.