Conversations at their death’s door

Marie and her rosy cheeks

I was asked to review the radiotherapy plan for Marie when I noticed on the CT images that her entire left lung was opacified. It turned out to be a haemothorax, as suspected. Her malignancy had resulted in auto-antibodies rendering her clotting system defective.

Two weeks ago I first met Marie in the clinic. She came with her son, daughter and daughter-in-law. They were obviously concerned about their mum and wanted the best, yet they understood there was only so much Medicine can do. Marie was in her fifties, but she did not look so at all. She came in well-groomed; her cheeks and lips were rosy with mild makeup. She had the gentlest speech, and her smiles were small, but frequent and sweet.

Now Marie was on the hospital bed in the trolley bay. No makeup this time — her complexion was pale, her lips grey, her hair messy from prolonged bed-stay. But she was still soft-spoken, and her smiles were still lovely as before.

I slowly explained to Marie what I found. “Things are progressing quite aggressively… And I’m not sure how rapidly this is going to continue,” I said as I watched for her reaction. “I’m really sorry, Marie.”

“That’s ok,” she said with a smile. It was as if she had expected this all along. “As long as the children are ok,” she added in passing. I didn’t quite understand at the time, but my mind drifted, for an instant, to recall the image of her son, daughter and daughter-in-law during the first clinic consult. She passed away the next day in the hospital.

Kenny and his dreams

In the same week, I had a conversation with Kenny. Kenny was a young man from Hong Kong. He had a wife Yen, and together they have a 5-year old son, who couldn’t understand yet that his dad was dying from colorectal cancer.

In a matter of days Kenny went from walking to being wheelchair-bound. On the CT images, his whole abdomen was solid with metastases. We knew his wife, brave as she was, was struggling to care for both Kenny and their little child at home. It came the time when I advised for inpatient admission to the palliative unit. It may very well be Kenny’s last destination in this life, and I wanted to make sure he and his wife understood the situation.

I remember his wife was wearing a T-shirt with verses from the book of Phillipians on it. I asked her about it, and it turns out I knew the church they attended. I realized too that when patients have a faith and hope to hold on to, these grim conversations become so much easier. I asked how long have they been in Australia for. It was two years ago when they came with their young son, on a working visa.

“What is it that you do?” I asked Kenny.
“I’m a lecturer at RMIT…”
“Oh what do you lecture on?”

“Building construction,” he replied, then added after a pause, “But all of that doesn’t matter anymore, Joseph.”

I guess that’s true. The following day Kenny’s cancer perforated his bowels. He was transferred to a private hospital, and that was the last I heard of him.

These conversations with Marie and Kenny at their deaths’ door helped me put some things back into perspective.