When my patient died alone, I felt hollow. But to whom did I owe an explanation?
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Version 0 of 1. “This 76 year old migrant lady lives alone and came in after a fall,” the intern said. “But she looks well now and there is little to find on examination.” After confirming the account my mind turns to how we will eventually get her home. My hospital attracts a disproportionate share of the poor, disenfranchised, refugees and socially isolated. She is another example of just how lonely life can be for many. Related: Death with dignity: how music eases grief's deep ache “Who is in your family?” I ask her. “Nobody,” she replies. There’s always somebody, I think. We just have to find them. Discreetly, the intern circles the paramedic’s observation: Squalid home, smells of vomit. “How are you managing at home?” I ask gently. “Fine,” she shrugs. “English only little.” I reassure her we will return with an interpreter, adding, “The paramedics were worried about your safety. Would you like to discuss finding somewhere else to live?” From experience, this seems the least objectionable ways of flagging a delicate matter but her obliging expression turns to consternation. “No, no,” she wags her finger and purses her lips. “I stay home.” She is genuinely upset now. I’m kicking myself; I determine to hear her out with an interpreter. That night she suddenly crashes, goes to intensive care and defying all attempts at salvage, dies. The others are surprised but I am stricken by an unnameable emotion, a swirl of remorse, anger and disappointment at the lost opportunity to redress her upset. When you think you have wronged a patient there is no harsher critic than your conscience. No, we didn’t anticipate her death. Yes, she went peacefully. Feeling hollow, I decide to call her relative; I owe someone an explanation. I am sorry she was upset but really, we weren’t going to pack her off to a nursing home. No, we didn’t anticipate her death. Yes, she went peacefully. Such explanations are necessary rituals that assist closure. I nearly always call a relative of the deceased because it seems like such a small yet humanising gesture. To be honest, relatives are often astonished that someone cares about their loss; I am mostly chastened by this low expectation of the “caring” profession. True to the patient’s word, no relative is listed, so I locate the hospital morgue. The guard says doctors don’t routinely ask to enter: “Did something bad happen?” “Well, she died,” I say, not knowing quite how to convey the emotion of losing a patient unexpectedly after having fallen short in one’s duty of care. He cements my disappointment, saying she was released to the coroner. Intent on finding someone, I track down her council carer, a genial man who kept an eye on her. He confirms that she was entirely alone but bristles with indignation when I mention her squalid home. “I disagree. She always kept her house tidy but must have been too sick lately,” he said. In touching details he describes her devotion to her old dog, her sole companion, around whom her life revolved. “Would she have gone into a nursing home?” I ask tentatively. “Never. She and her dog were going to die together.” As if sensing my contrition he sends me the details for her funeral and I later find myself battling the GPS to locate a tiny Orthodox church whose gates are firmly shut. A plain coffin waits outside, adorned with red roses secured with a white ribbon. The funeral director laments that he has rarely seen this extraordinary situation of a funeral without mourners. With two minutes left there really is no soul in sight. I start to feel uncomfortable. Just then the carer arrives. “I am so glad to see you,” we say simultaneously as an imposing priest slowly walks up. The carer and I stand together. I have been to patients’ funerals but never one like this. Yet it seems both awkward and right that I came. A simple cross with her name lies unclaimed – the carer offers to carry it. With him joining the procession I am left as the sole guest. Just then, four women bustle in and I exhale. In the soothing interior we stand some distance from the open coffin as the priest prays in a foreign tongue. The women know just when to break into melodious song. The priest holds the patient’s hand and talks gently and expansively to her in a way that reminds me of a satisfying ward round. When he kisses her head the women follow suit. I approach her with trepidation. Hospitals are good at making patients anonymous but now she looks restful in a handsome cream gown. I touch her hand, ice cold and alien. I am sorry we couldn’t save you, I say silently, and I am sorry about upsetting you, but your beloved dog is safe. The service over, I hope the priest and the women will shed some light on the lonely patient. But the priest has never met her and the singers just couldn’t bear the thought of a silent funeral. “So who organised this?” I wonder. “She left meticulous instructions down to the name of the priest and the flowers,” the carer reveals. Her meagre savings she left to her dog, our final confirmation that she really had no human ties. Inside, there were no tributes or tears. Outside, there are no doves or balloons. We will never know what experiences led her to live the way she did. But I like to think that we strangers accorded a fellow human being the dignified and respectful farewell she deserved. Related: Why funerals are the new weddings | Fay Schopen You could tell that the priest felt his responsibility deeply. I praise the four women for singing as if a thousand mourners were watching and they beam with pleasure. I thank the carer for calling me and observe that people like him ennoble us all. The man who was just doing his job turned out to be her only friend and loyal defender. My heart soars at the kindness of strangers in a jaundiced world. She is about to depart for the cemetery. “What should we do?” I ask doubtfully. “I’ll go,” the carer says softly. “Just in case someone wants to know one day where she is resting.” |