The art of living and dying

6 minute read

‘I sat on the bed and cried, silently, and I pleaded both for it all to be over, and for it to never end.’

It’s difficult sometimes to separate memory from fantasy. We think we hold a moment experienced in time with objective clarity, a sense that it must have been just so.  

And the problem with being a doctor and, to some degree, a writer, is that our minds are bombarded daily with myriad experiences of the complexity, messiness, and largeness of what it means to be human. 

In my first year out of medical school I worked in a large, tertiary surgical hospital in my hometown of Edinburgh. The four-month job on the colorectal unit was preceded by all sorts of rumours: tyrannical, whimsical surgeons reputed to throw surgical implements at unlucky registrars assisting them; weekends on-call when two junior house officers somehow had to keep a track of over 100 surgical patients; and the inevitable, relentless, and inescapable demands of the wonderful, stoic, unwieldy, and outdated NHS.  

One night I received a rushed handover from a harried colleague; a woman who had undergone major abdominal surgery and who had been transferred out to a stepdown unit was coming back to our hospital with abdominal pain for exploration. “Mr Smith will take her to theatre in the morning.” I remember little else of the clinical details. 

A few hours later I was called to the ward by a nurse. The patient had become delirious. She was sitting up in bed gasping for breath and looking at me with both an emptiness and a piercing look of terror. “Call my husband. Please call my husband.” She could tell me nothing else. 

I started to examine her, gently trying to hold her hand to calm her and simultaneously feeling for her radial pulse. Fast and thready. I put my stethoscope in my ears and put the diaphragm against her chest wall. Her breath sounds were loud and rasping, and her heartbeat raced along, thumping like the wheels of an Edinburgh taxi over cobbled streets. I had little time to think or do anything. 

And then silence. 

Her chest became quiet. The stillness within the comfort of my stethoscope earpieces was eerily calm. The next minutes were a blur as I lowered the back of her bed and started CPR, calling for help. Nursing staff ran in and called the emergency team. Soon the room was swarming. A medical registrar and her resident took over, and I stood back, watching in a haze as the predictable scene unfolded before me. 

My pager alarm startled me back to the present, and I headed off to my next hopeless task. 

Ten years later, in 2021, I took a different journey with someone who was dying.  

This woman had just passed her 41st birthday as the metastatic disease in her liver decided it was time to obstruct her bile ducts and multiply at a new rate of knots. Simultaneously, fronds of leptomeningeal deposits snaked their way along sulci, constricting and compressing, sending off focal seizures to distant limbs.  

She too vacillated in and out of delirium, moving from the bed to the toilet in the ensuite and back again. I laid out the medications delivered by the palliative care team on the kitchen island; an unsavoury collection of ingredients the kitchen had never yet seen. I resited the subcutaneous line which she had pulled out in her confusion. I drew up midazolam and fentanyl and tried to bargain with her to let me administer it.  

Next door and downstairs our children, aged five and nine, slept calmly, somehow.  

We went between the hospital bed we had in our room and the toilet, all night long, every journey there and back an odyssey that I felt would end with one or both of us falling.  

Was this the dark night of the soul, of which St John of the Cross wrote? God felt very absent; I felt like I was very much alone with my wife, 20 years of history and love and life between us, trying to honour this wish to be at home as long as she could, as long as there was no distress to our children. I sat on the bed and cried, silently, and I pleaded both for it all to be over, and for it to never end. 

With daylight, the delirium seemed to settle a little. Or maybe it was just a mother’s love that, somehow, got her to the sofa to say goodbye to her children, all dressed up for Book Week. She lay there, dozing, while our daughter read to her. And then they said goodbye. 

From there, things moved quickly. I called the hospice team to say that she needed to be transferred. Miraculously, the three-bed cottage hospice had just had a room “become available”.  

I guided the paramedics down the stairwell as we said goodbye to our home, the first house we had owned together. I whispered to her. “We’re going to the hospice now. You’re safe, my love.” The sun shone on her face as the stretcher was wheeled into the ambulance. 

Twelve hours later, at midnight, the night nurses woke me to tell me her breathing had changed. My children were asleep on mattresses on the hospice room floor, where they slept in my arms. I eased myself out of their sleepy embrace and crawled into bed with my wife, one last time. 

I listened, for one minute, then two. Her breath changed, stopping and starting. Not gasping or distressed. My arms circled her, like a thousand times before. And then the final exhale, and silence. 

Eighteen months on and there is still a silence there. We live both in her absence, but with a profound sense of her presence. We say her name – Eva, Mama – and call her into our everyday. She is gone, and we are changed. And the dustiness of memory comes and goes and we hold on to the best and the brightest moments, and cry in the hardest. And somehow, through it all, she taught us the art of living and dying. 

Dr Simon Menelaws is a GP who works currently as a medical advisor within the federal Government’s Health Professional Advisory Unit. 

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