Til Death Do Us Part

I see bodies at the very edge of life.  

I see bodies when the hearts within them are barely able to send the blood they pump to the tips of fingers and toes.  I see bodies whose lungs are squashed, scrunched and crispy from a lifetime of whatever air and debris has reached and settled within their alveolar spaces.  I see bodies riddled with cancers that are known, and I’m the one who’s broken the news, and those that will never be known about because the owner of the body is happier not knowing.  I see bodies full of infection, which in older people often means an associated delirium which renders the recipient a different, distressed version of their known self.  I see bodies of patients who cannot get out of bed without people or equipment to help and look into their eyes as they beg me to let them go home.   I see bodies that have long since lost the memory of who they are, who I am and what this world is that they inhabit.   And, finally, I see bodies where life has gone completely and their last medical rite is for me to confirm that this is so. 

Of course, these are not bodies.  These are people, wonderful human beings, with all the laughs, frustrations, tears, joy, sadness and adventures that life has thrown at them.  Most of my patients are around 90 years old.  If I have a patient in their 70s, that’s young.  I often remind my parents of this; retiring in your 60s, you still have at least 50% of your life to do again.  I may have romantic notions of adventuring and then growing old in a house by the sea, reading, painting, playing my violin, writing, playing games and drinking tea, all surrounded by family and friends until one day I simply fall asleep, never to wake up.  But you don’t know what your old age is going to look like.  To look after older people is to consider your own life and death, because you are experiencing that of others on a daily basis.  

So when I read that I’m supposed to be having an epiphany about giving ‘individual’ end of life care, I can only assure the rest of the world that this is no epiphany at all to any junior doctor.  Who could love a job like mine, where so much of it requires looking death in the face, were it not for the care of the individual?  If I am lucky I will be able to do discuss a patient's diagnosis with them and plan their final weeks, days or hours as they would wish.  But I, and they, am not always so fortunate.  I recently was called to see a patient who was clearly going to die within minutes of my arrival - as the on-call doctor, we were meeting for the first time.  That did indeed require a 'snap decision' that meant I could give this patient the dignified death they deserved.  It meant I could look the relatives in the eye and say truthfully that their loved one had died in peace and without pain.  It meant that this patient had two of us holding their hands when death parted our worlds.  I know the conversations I had with the family during and after that time will never be forgotten - strangers before, I am now and forever part of that life.  

People often think I’m a bit weird for wanting to be an Oncologist because of the close professional proximity I will have to death.  This belies the fact I already look death in the face in some capacity on at least a weekly, if not daily, basis.  Each conversation and experience is different because each patient is different - that’s what being a doctor requires in life as well as in death.  Perhaps I should be relieved that there is a bit of government guidance that tells me to do what my colleagues and I are already doing?  Instead I feel a little bit of my heart sink; a disappointment that patients from my past might think that I didn't see them as individuals because only now am I being explicitly told to do so. 

Don't tell me I don't know what death looks like.  I see bodies at the very edge of life and see the individual underneath.  I'm not sure my fellow junior doctors and I were ever in any doubt about the importance of that.