I have no difficulty finding the house as I have been visiting here with increasing frequency over the last months.
I turn at the end of the road and park in the usual spot. I notice that the sun now has some warmth in it, very different from through the winter when I rushed into the house to get out of the cold. I pause, noticing the cherry blossom. Spring is definitely here. And this is a very different visit. I leave my doctor’s bag and my clipboard of patient notes in the car as they won’t be needed, because the patient I have been helping care for at home has died and I am visiting their widow today.
However many times I have done a visit like this I still have some trepidation. I am meeting someone as they are living through a huge milestone in their life, full of the raw and confused emotions of grief.
As I come in, I note the hospital bed and other equipment awaiting collection. Even a slight smell of hospital lingers here. Yet the house has transformed, from the place where a stream of carers and professionals attended day and night, to a new cast of supportive friends and families and a mantelpiece lined with cards.
We talk about the last few days. Our modern lives leave most of us woefully unprepared to deal with death. The experience of palliative and terminal care, especially in our own homes, can be overwhelming or else strangely satisfying. None of us can really know how we would cope with the caring tasks, the bed baths and commodes, the syringe drivers and the medication. I know that one important role for all of us is to be professionals who are neither scared of nor a stranger to death. It is okay to ask things that would not normally be asked and to admit darkest thoughts. “His breathing kept on slowing until it seemed to stop, and just when I thought he was dead it restarted. I found myself willing it all to be over. Is that normal?”
There are practical issues to attend to. The medical cause of death certificate is explained and any other questions answered. Unused medicines need to be returned to the pharmacy and an undertaker contacted.
I had known this patient for over ten years, but I didn’t know everything about him so it’s lovely to hear about how they met at the local dance hall. Experiences that sound so fresh but also so much from an earlier era. Then their young family and working life. All of this gives me new insights into the sort of person he was and moulded the way he wished me to care for him. I am aware of the conversation becoming a bit lighter, perhaps surprising at such a solemn time. There is even a good chuckle over a shared memory, both of us glad to remember him when he had a vibrancy that faded in the last weeks.
I remember a senior churchman describing grief and bereavement as ‘the last task we do for our loved ones’. This seems so true. I do not have medication to make it any easier unless it later tips into clinical depression. It is a confusing time for the bereaved; the initial numbness to what has happened is unnerving. Then there is the restless searching, interspersed with irrational moods and the more expected deep sadness.
It is not surprising it is so painful; I believe we are heavily defined by our human relationships. “I am because we are,” as the African philosophical concept of Ubuntu states. The stronger the relationship, the more the loss of a close one leaves us with a deep and painful void. Healing takes time. Like a surgical scar it hurts intensely initially and although the pain fades with time, it will still be sore months or even years later. This is a memory of our life experience and of who we are.
The textbooks tell us the process is an orderly one and we assume it is predictable. The reality seems to be far from that with a chaotic mixture of emotions and unexpected reactions. The most important advice? A hefty dose of self-empathy and self-care to get through the process. And this is crucial here as for the last few months, the wife’s attention has been solely on her husband. That pressure is now off, and her response is one of exhaustion, as her body is given permission, finally, to take a break.
After offering her a check up appointment in a few weeks, I say my goodbyes. I walk down the drive. A blackbird sings and two house sparrows fuss in a dry dust bath. Ubuntu is much in evidence. One part of me knows that staying objective means I am able to offer the informed advice that is needed. The other part of me feels the human connection that drives and energises the care we give and ensures it is framed in humanity.
Dr Miles Mack is a GP in the Highlands and the former chair of the Royal College of General Practitioners Scotland