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Going easy

April 9, 2019

Deloris bore a striking resemblance to the appearance of someone who had swallowed an inflated beach ball. She was as tall as she was wide and the curvature of her stomach resembled the gentle arc of a classroom world globe. The magnificence of her girth was surpassed only by the magnitude of her smile and the pleasantness of her character.

 

The problem with our working relationship was that it was very one-sided. Deloris was the giving one. She gave me her diabetes. She gave me her high blood pressure. She gave me her unique physique. But most of all she gave me her tiny little coronary arteries. The extent of my giving was when I put pen to paper and wrote out the prescriptions for her numerous medications.

 

The narrowing of Deloris’s coronary arteries caused frequent episodes of chest pain whenever the extent of her physical activities surpassed the capacity of her arteries to deliver oxygen to her heart. Having a shower was enough to bring on chest pain and she had to puff on her angina spray before she could even contemplate carrying out her morning ablutions.

 

Deloris was already on massive amounts of medications when I met her. There was very little room to manoeuvre upwards with her doses. In the past there had been talk about surgical procedures to open up the arteries but they’d never happened as her overall condition was so poor. She was a walking time bomb.

 

Deloris was very open when it came to discussing her medical issues. She knew that one day the arteries to her heart would close off completely and she would have a heart attack and die. She also knew that I would likely be the one who would be looking after her when that time came.

 

“I want to die here in town, in this hospital,” she would tell me.

 

“Yes, yes Deloris,” I would reply with a smile on my face, “But that won’t happen any time soon.”

 

But it did, and I wasn’t ready.

 

She came in on a Saturday afternoon with the usual pain. Except it wasn’t the usual pain because it was worse and it wasn’t going away with my usual tricks. The oxygen was turned up high. A drip was inserted and drugs given. But – the pain remained. She wasn’t overly distressed and she was stable but – she wasn’t getting better.

 

I decided that she should be flown out by the RFDS to the nearest large referral hospital 450km away. I know she hated me for that decision, but she went nonetheless. As she was wheeled down the back ramp of the hospital into the waiting ambulance to be taken to the plane she smiled and said, “I’ll be back before you know it.” Sadly, I think we both knew she wouldn’t.

 

Over the next few days I kept in touch with the registrar in the receiving cardiac unit. I knew him from med school so it was easy to get information and there was none of the pretentious bullshit that you got when you rang some other doctors. He wasn’t out to impress me and he certainly wasn’t going to talk down to the “country bumpkin” GP, like some of the others did. He knew that if he was here doing my job he’d be shitting his pants as well.

 

In the larger hospital Deloris initially stabilised but then, she deteriorated further. None of the medications were helping and she ended up ventilated in ICU. Then, after all measures were taken and there was nothing but futility in sight, they called in the family, turned off the drips and the respirator and she died far, far from home. I felt a total failure.

 

Later that week the funeral took place in a tiny little church at one of the nearby towns. The church was small and it was standing room only. I stood outside listening and watching through an open window. It was hot and dry. Nearby in a tree sat a crow, singing a monotonous song to a regular beat. Once every couple of minutes or so it let out a moan like cawwww which started high and ended low. It was painfully melancholy. All through the service that damn crow let out its plaintive cries. It felt like it was mocking me.

 

At the end of the service I was glad to leave the church ground and join the parade to the nearby cemetery. The crowd huddled around the graveside as the pastor made his final speech and the relatives bade their farewells. I stood towards the back of the crowd with head bent low and a heavy heart. The crow had followed us and was perched high in a nearby gum tree – silent. The pastor murmured “Amen”, the family tossed in handfuls of soil and the attendant triggered the mechanism to lower the coffin slowly into the grave. At that, the crow dropped from its perch and glided over the heads of the gathered crowd, over the grave and into the bush in the distance. Not once did it flap it’s wings and as it soared majestically through the air it let out one last long mournful ca-cawwwwwwwwwwwwwwww. I felt the hair stand up on the back of my neck.

 

Afterwards I went to the wake. Small groups of people eating finger food and sipping on beer. I tried to blend in and keep a low profile. But then, one by one, they took their turns and appeared out of the crowd. They would offer their hand and a firm handshake to thank the doctor that had looked after Deloris. Brothers, sisters, daughters, sons. I can’t remember how many there were but I do remember their hearts feeling lighter now that her pain was gone. Their gratitude for my care was palpable. My problem was that I still felt guilty about letting Deloris go to the “big smoke” rather than let her stay and make her final journey at home.

 

Our greatest enemies are often ourselves. We self-analyse, self-criticise and end up self-loathing because of what we perceive as sub-optimal responses in difficult situations. If I had been an experienced cardiologist I may well have made a decision that Deloris should be made comfortable and wait for the end at home. However, as the only doctor in a tiny country hospital in my third year out from graduation I made what I thought was the right decision at the time. Looking back on it now I’m surprised that I came up with any decision at all.

 

Hindsight is 20/20. The retrospectometer is always crystal clear. Life would be easy if we could live it back to front but we can’t. So.... go easy on yourself when those decisions that you thought were the right thing at the time go pear-shaped once in a while. None of us are perfect.

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