Here is what I have put down:
The Importance of Saying Goodbye
This afternoon I need to visit
Trevor at home. Trevor is a fifty-eight-year-old man who is terminally ill with
bowel cancer. The district nurse informs me he likely has only a few more days
to live and requests my visit today. Something exists which is called the
two-week-rule. If a patient dies, and that patient was seen within the last two
weeks, I can issue a death certificate. If not, the coroner needs to be
involved. Trevor’s family will be distressed enough when he dies, they do not
need the added distress an autopsy would bring.
* * *
When I arrive at his door,
Trevor’s daughter opens the door, “Thank you for coming, doctor. Dad is in the
back room.”
I hardly recognise him. Trevor
used to be rather plump but today Trevor resembles a skeleton, his ribs and
jawbones protrude. A glint lights up Trevor’s eyes, “Nice to see you, doc, not
seen you for a long time.”
“Yes, you are right, it must have
been a few years since I last met you. How are you holding up today?”
Trevor points to the
syringe-driver, “Much better since you increased the pain relief, thank you.
Managing okay now.”
We chat a while longer and Trevor
tells me how it won’t be long now, “I can feel it in my bones.”
Trevor’s wife, two daughters and a
son-in-law sit around his bed. Mary, Trevor’s wife, wipes away the tears from
her eyes and one of Trevor’s daughters wraps an arm around her, “It will be okay mum,” while handing Mary a hanky and
wiping her own eyes.
* * *
This may very well be the last
time I will see Trevor alive. To be honest, I agree with the district nurse; I
don’t expect Trevor to last the weekend. Although I am strapped for time, I do
everything in my power to give the impression I have all the time in the world
for Trevor. Still, at twenty-five past two, I get up and say goodbye to Trevor.
As I walk to the front door, Mary
and her daughters follow and take me to the side, “How long do you think Dad
has left? Should we ask Bill to come over from America?”
Bill is Trevor’s son and if Bill
wants to be here before his father dies, he should really be quick. How can I
word this without upsetting the family even more? “I can’t really say how long
it will be. Anything I say is only a guess and Trevor may surprise us. My gut
tells me this is a matter of days, but as I said, he may surprise us.”
The eldest daughter meets my gaze,
“Thank you, doctor, I will phone Bill as soon as you have left.”
* * *
Before I leave, I feel the need to
inform the family of some practicalities. Today is Friday and I won’t be back
at work again until Tuesday. If Trevor passes away before I am back at work, a
death certificate will need to wait until my return. In the past, the
Out-of-Hours service has mistakingly informed families to pick up the death
certificate at ten in the morning on the first working day. This is not always
possible, and the delay distresses the family more than is necessary. I need to
do all in my power to avoid this.
Mary turns towards me, “Thank you
once again for coming doctor,” and opens the door.
As I say my goodbyes, I wish the
family all the strength they need during this difficult time. If only I could
do more.
While I drive home after the visit,
my thoughts return to Trevor, Mary, their daughters and their son Bill. Will
Bill make it in time to say goodbye to his father? I hope he will.
* * *
A few days later I find out Trevor
passed away early on Sunday morning in the presence of his family. Bill was
able to get home in time to say his goodbyes. A relieved sigh escapes. Being
able to say your goodbyes can make the grieving process so much easier. It will
still be hard, but at least it won’t be complicated by feelings of guilt caused
by not making it on time.
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