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The Art of Palliative Medicine - 2016 Semester 1

This poem tells the story of a woman dying alone and the difficulties of being involved in the medical care of such a person. I had noticed that news stories, books and films tend to tell the story of the dying patient as a hero conquering their illness and inspiring others to live more appreciative lives. I wanted to tell a less "Hollywood" story, where problems were not resolved and the patient had not found meaning in her illness, leaving me less satisfied as an observer. Carrying out the interview and reflecting on it afterwards helped me to become more aware of my own expectations of dying patients as I realised that I was hoping she would be optimistic and philosophical about her death, and was disappointed to find that she was sad and scared and lonely, which was a lot harder for me to deal with. In the poem I contrast this experience with another interview with a cancer patient who had reacted completely differently to her illness, helping me to reflect on the diverse range of reactions people can have towards terminal illness and making me consider how I could best deal with each of them.

PDF version of "And How Would You Describe The Pain?"

She was a former model but
She was not a model patient
She did not make terminal illness appear trendy.
She did not radiate optimism
She did not possess an indomitable will to beat her illness
She had not given her cancer a suitable pseudonym
To assert her dominance over this unwanted invasion.

Her neighbours did not bring around lasagne
Her husband was long gone ("a widow for years")
Her son was expecting another child
So would not have time for her.

She had friends who were dying too
They sometimes went into respite care at the hospice so their husbands could have a break
Her husband was dead
So she did not qualify
Although she could have done with a break from looking after herself.

She spoke of an in-between feeling
Not a sensation of the tumour creeping in between the lungs and chest wall
But the in-between of
Not knowing if it was weeks or months
The in-between of
Not sick enough for hospice but struggling at home
The in-between of court cases and ACC disputes
Even our conversation swung between
The difficulty of dying
And favourite coffee brands.

She spoke of fear:
Her biggest fear was dying alone.
Her biggest fear was that she would be put into a rest home.
Her biggest fear was a long, drawn-out death.
Watching hospice friends die, one by one, she was afraid she would be next.
I think she was also afraid she would be last.

She nearly cried
Talking about her husband dying
              her friends dying
              the shock of her diagnosis
              the lack of support
              being alone

I nearly cried too.

The day before, I had observed an interaction
Between a doctor and a body with metastatic cancer
Brought in by its owner, a bubbly 30-something, and her husband.
The three discussed the body’s calcium levels and thyroid problems,
Fatigue and the gas in the stoma bag,
"More blood tests!" was what the body needed, and the couple had agreed

This was much easier.

I had seen dying before, but from a distance,
Not this prolonged, lonely dying –
I had not sat for so long in this place where questions have no answers
Where problems have no solutions
I had not looked straight into a dying face
And asked how it felt to be there.

I could only make feeble observations:
"That sounds really difficult."
"So it seems like you feel quite unsupported?"
"It must be hard not to know."

What else could I do?

I have learnt the skills of using stethoscopes,
Tendon hammers, sphygmomanometers, butterfly needles
I would like to learn the skill
Of putting them down
Knowing when a patient has had enough of being a primary-tumour-poorly-circumscribed-
With-widespread-mets-secondary-to-haematogenous-spread
And today, just wants to be a person.

If there are right things to say,
I would like to learn these.

If there are no right things to say,
I would like to learn this too
And learn how to sit in this space
Where we cry in between
Eating chocolate chip biscuits
And drinking Hummingbird Crave.

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