It's been a bummer of a Tuesday. It didn't really have a chance to be otherwise, considering that the fist message I got on arriving at this office this morning was that a patient of mine died yesterday. I say 'a patient of mine' but he wasn't really. He was usually seen by a colleague who was off yesterday. He was on the palliative care register and this meant that he was terminally ill and would be receiving only TLC to make him as comfortable as possible until the end came. This was his choice. I had heard about him previously when he had been discussed in the palliative care meeting which we hold once every month in the Practice.
So I went to see him yesterday by the request of his carers. According to them, he was more drowsy and I got the impression that he was deteriorating. However, when I got to his home, he was lucid. He was alone, as the carers had left; bed bound as expected but was quite alert and trying to tell me something. Our communication, was unfortunately hindered by the fact that he was stone deaf and he mumbled. I could not understand a word he said, and obviously he couldn't hear a word I said. After several minutes of good-natured but confused back and forth between us, I decided to go back to the practice and arrange for the district nurses to help him out with several things and wait until the carers called again so I can figure out what exactly they wanted me to do with this man who was dying and didn't want anything done with him.
As I took my leave of him, he turned his face fully up to me and said, 'I have not seen you before'. Clear as the sky on a crisp winter morning. I was so taken aback, but responded, telling he was indeed correct and I introduced myself. When I repeated that I would be on my way, he put his right hand out from underneath his blanket, between the bed rails, and I shook it. Then I left him - alone; with nothing but unkempt garden to stare out from his bed, through his patio doors/
And this morning I learnt he had died four hours later. I was so shocked that I cried. I cried in the morning speaking to my supervisor and I cried in the afternoon speaking to his usual doctor. But, I am not sure why. I am four years post-graduation. I have certified deaths; had someone die whom I was in the process of examining at the time. I have had patients in hospital alive at morning ward round and dead by the afternoon and I have not cried. Sometimes, I would think, 'Oh dear'; or 'Oh that's sad'; or 'Please let me not be here when he dies' (that prayer was answered-and I didn't cry when I found out). However, this particular death of a ninety-nine year old man really shook me.
I know it is something I have to get used to dealing with. As I train to become a GP in a country with an aging poplulation, this scenario will not be a strange one. I suppose the only way I can learn to deal with it is to confront it. Take those palliative care cases and see them through instead of shying away.
It is something I have to do. Today, though, I have had a portion of chips as comfort food (couldn't have chocolate as I have given it up for lent and still have four days to go), therefore earning myself 10 extra minutes on the stepper when I get home. But I am looking forward to my evening of writing. At least then, no one has to die. Not yet anyway. Not if I have anything to do with it.
Enjoy the rest of your day and stay alive.