It is a madhouse in the Emergency Department. The corridors were filling up with ambulance trolleys carrying the Saturday night specials of drunken assaults and suicide attempts. Somewhere in all that chaos were nursing home residents waiting to be seen, and the thousandth chest pain, abdominal pain or sick child.
There was a gentleman they had to intubate and move out of their Emergency Department to a tertiary hospital. He had been assaulted that night and had blood in his brain, with a fluctuating conscious state. That meant one less senior doctor in the department, as the other registrar had to accompany this man on the ambulance.
And then there was the lady, who was on blood thinning medications, who had come in a little confused with blood in her urine, and so the doctor had quickly seen her and ordered a brain scan, just to rule out a bleed into the brain. Which was exactly what she had, and he sighs as he picks up the phone to make the necessary calls to move her out of the department.
Even Though I Walk Through The Valley of The Shadow
In the midst of all this comes a man, in his fifties, on a trolley. From all the way across the department, you could see that this man was dying. He was all skin and bones, his eyes were rolled heavenwards, and his gasping breaths suggested that he had not very long left to live. There is a woman standing next to him, her tears and eye bags suggesting that she is probably the wife.
He was given a Category 1, which meant he needed to be seen immediately. There was a bit of a delay finding him a cubicle, but the nurse-in-charge expedites the process, trying to save this man the indignity of dying on an ambulance trolley.
"The wife wants everything done for him," whispers the nurse-in-charge once they place him in a cubicle, as the doctor reels back at the suggestion.
"Go have a quiet chat with the wife," says his consultant, who had kindly stayed back to help manage the extraordinarily busy Emergency Department that night.
He hesitates a little, and tries to distract himself with other less urgent tasks at hand, as he envisioned a lengthy discussion with the wife about why they shouldn't be taking blood tests or performing scans.
The nurse in charge of admissions sees his hesitation, and calls him to task - "You'd better see him, now, doctor, or he might not be breathing when you do get to him."
He stands up and taps the table twice in frustration, as there had been nothing easy about tonight. Sick patients all over the department, and he was about to lose another senior staff for a few hours.
He is about to walk into the cubicle when he sees the teary wife, whose weary eyes spoke volumes about the awful journey she has had to endure these past few months. He finds out that this gentleman was on the palliative care team for metastatic gastric cancer, which means that the cancer had traveled beyond the stomach into other parts of the body.
I've been sleeping on the floor just to be next to him you know he was having trouble breathing tonight and he had coughed up blood and he's just not himself you know and he was telling me yesterday how his mind was absolutely perfect but it was his body that was weak...
He puts an arm around the wife, and a nurse sits her in a chair outside the cubicle. The doctor pushes past the curtains, to be greeted by the sight of this man. His cheeks were sallow, and his eyes looked as if they were bulging out of the sunken sockets around it. There was barely any fat or muscle, as the skin hung limply around his arms and legs - signs of cancer ravaging his body, greedily stealing nutrients from him.
A quick assessment reveals that this man was dying. He barely responded to the doctor's questions, and one of his pupils were bigger than the other, suggesting that there may have been undiagnosed cancer going to his brain, and the way he was breathing - the dying gasps - suggested this man didn't have very long left.
He walks out to the wife and he kneels beside her. I'm sorry, he says, and stops there.
Should I call the children? is all she asks. He nods quietly.
To Be Surrounded By Loved Ones
After a mad scramble around the department, the doctor returns to the cubicle on request of the nurses. The gentleman's passed on, they said quietly.
In this tiny room were now cramped this man's four children, overflowing to the outside. He walks past the red eyes, nods his condolences to the family, and gently offers them a few more minutes with him.
The doctor walks away, and tries to suppress the memory of losing his own father about that age. He wanted to tell the family that they would be all right in the end - that life would work itself out - but now was not the time.
Now was the time to grieve.
The Lucky Ones
They move the body into a quieter room, with enough space for family to surround him. The Catholic priest is called in to pray over the gentleman.
The doctor and the nurse-in-charge walks in to the family, almost intrusively into this very private space of sadness, and offer their condolences. They explain what needed to happen from this point, and handed out a brochure to the wife.
He's so young, protested the wife, lovingly brushing the head of the man she will never wake up next to again.
Well, at least he's one of the lucky ones, says the nurse-in-charge.
Everyone's head in the room looks up, including the doctor's. What an odd thing to say. What was so lucky about dying young?
At least he's surrounded by family who loves him. Most people don't even get that, says the nurse-in-charge. The doctor is not sure what scant solace this must offer the family, but they seem to nod their heads in agreement.
This is not the man we know, this is not the man we know, the wife cries, her face grimacing in tears, as she kisses him on the forehead. Her words bring fresh tears to the eyes of all those present.
The doctor steps away quietly, trying to ignore the lump forming in his throat.
*********************************
He sleeps like the dead when he returns from his night shift. He wakes up and sees the evening sun through the drawn blinds in his room. He gets up and takes a much needed walk in the park opposite his house. It is a pleasant spring evening, and there are dogs running around the park, chasing tennis balls catapulted by their owners into the air. The park is filled with joggers, and friends kicking the football around, and five year olds stopping their bicycles for a quick drink by the water coolers littered around the park.
He breathes in the evening air, and watches the tiny new leaves springing up on the naked branches of trees stripped bare by winter's cold touch. He thinks about the cycle of life, and death, and his heart holds on to the promise of spring.
