​Last night, i cried so long for Mrs S.

When i first got called to see Mrs S on Thursday night. I knew immediately with that punch in my gut that she was not going to do well. I read through her file and in my heart i knew that the chances that this would be a terminal event is too high. She had a whole horde of family members in the room. Hopeful eyes settled on me. Talking to me at all once. Everyone was seeking for answers. Answers that i didn’t have.

I had to put my foot down and explained respectfully that my priority lies with my patient first. I needed to stabilise her first. Everything else can wait. Her family immediately quieten down and stood back to watch. 

From the end of the bed, i saw this extremely frail and cachetic lady. She had increased work of breathing but no obvious stridor or evidence of upper airway obstruction. She was alr on 15L oxygen which was barely helping her work of breathing. She hasnt been producing much urine which meant that her kidneys were shutting down. Her chest sounded bad and she had a temperature. She was intermittently drowsy. Her hand were flaccid but warm however. I went into my investigative mood and did a septic screen. Started her on antibiotics. In my head i knew that this would be the event that would take her life unless she responds well to antibiotics but knowing that i know from reading her notes, im not sure if i believe it. 

I updated family on my plan. Called the specialist who was rightfully concerned enough that she showed up within 1 min after we hung up. After the specialist left, i stayed back to sorted out remaining stuff. 

Patient’s son followed me as i left her room. Stoic indigenous gentleman who initially had spoken to me in a harsh tone which took me slightly aback. It wasn’t until i had focused my attention to his face that i had noticed the emotions behind his eyes. He repeated his question this time in a slightly emotional tone,” how long till she go?” Because of all the prior talks about transferring her back to her home back in rural region, i had thought he meant if she was getting transferred back today. 

So i replied,” not sure but not tonight. We generally dont like to transfer unstable patients during the night. Too much at stakes. Im so sorry.”

“I dont mean that. I meant how long more till she goes?” 

It suddenly dawned upon that he wanted a prognostication. Words had failed me as i stared at him struggling to figure out what to say. 

“Im not sure because this is my first time seeing mom.”

“Based on what you saw doc. Please tell me the truth.”

“ Truth is. I don’t have the right answer for you. It is true that she doesn’t look great at the moment. She might be having ongoing infection. With all the disease burden from the cancer and her kidney is not trending great as well. But i cant tell you when it will happen. Could be hours, days. Or even weeks and months” 

“ -silence- Mom just wants to go home and be with dad. Can we make that happen”

“Unfortunately, i have no power over this. It will be best to wait for morning. All i can do is try my absolute best to help her get through the night. Im sorry.” 

He nodded as he headed outside for some fresh air.

Thursday night, i went to bed wondering if she was going to make it through the night. Sending her silent prayers and all. My heart resting heavily in my stomach. I could really use a hug right now.

Friday, i went to work earlier than usual so i can check if her name is still on my list. I waited with bated breath whilst looking at the circle of death that is the loading sign. 

My eyes scanning down the list. There she was. I released the breath that i was holding. I started rounding early so i can check in on her. I had alr skimmed through all the notes and i knew the plan was to facilitate her discharge via flying doctors. We were waiting for a helicopter. So i went up to see if we were getting any headway with RFDS peeps. But i kept getting called away to do something else.

When i finally made it back to her ward. I went into the office first and being the empath that i was i tuned in immediately to the emotions in the room. Nobody turned to look at me. But i was certain that someone is crying. Sadness and grief was thick in the air. I did what i had to do and headed out to see Mrs S. 

Except that her door was closed with a sign plastered on the door: “Please do not enter. Ask nurse first.” I know that sign. I didn’t have to ask anyone and i know she had left us.

The same nurse from ytd came up to me and said,” i was going to call you. It happened so quickly.” Words failed me agin. Somehow this keeps happening these days. I nodded. “Might give family some time before i go in to certify.” 

I then got a call to see Mr M who wasnt well. So i left and headed his way. Once i saw Mr M, i had contacted the registrar to ask for advice. The call went to voicemail. I sighed to myself. Weighing if I should bleed this poor gentleman. Was he febrile because of the cancer vs new infection. Deep sigh. I knew i had to do the right thing that is to bleed him again. 

Then the reg came to find me somehow knowing where i was. Her eyes puffy and red. Somehow my heart got heavier. Like the medical professionals we are, we compartmentalise and ignored the elephant in the room. I had asked for her advice and she told me what i knew i had to do. She apologised that i had to do more work. I said,” thats what i am here for though. Its ok. We do whats right by the patients right?” Red puffy eyes and small smile were her response. 

She handed over remaining jobs for me. Albeit apologetically. As we walked out together i asked if she was ok finally addressing the elephant in the room. She said,” not really. But i will be ok. I just feel so sorry for her.”

“ You did your best tho. We all knew it was gonna happen. I was really hoping that RFDS was going to make it to bring her back”

She looked visibly distraught as she said,”RFDS were going to come except there was an unexpected accident so they were redirected. Meanwhile, Mrs S kept going downhill. She couldnt get home in time to say goodbye to her frail husband. That broke my heart.”

“ But you need to know that you’ve done your absolute best. Dont blame yourself over things that aren’t within your control.” 

“Thank you for your kind words. Thank you for sorting her out last night. You did well too.” 

We continued down to the nurse’s station where she bid her farewell to them. Thats when it dawned upon me. Friday was end of term for the registrars. When she left, the nurse came back and said to me,” she is one of the nicest and most empathetic doctor i’ve ever worked with. I feel bad she had to end it this way.” 

Unfortunately thats the reality of this job. Sometimes, you end the term with on a sad note. That doesn’t mean that it wasn’t a good term. What matter most is that she left a lasting impression on the patients and nurses. She will be an excellent boss someday. Im sure of it. 

After she left, i went back to see Mr M again. I had known him for sometime now. Held his hands before while he cried. I’ve also lost count of the number of times he had spike a temp. The number of blood cultures he had in the last few weeks. Mr M looks even more jaded and upset than he was when i last saw him 3 weeks ago. 

He’d remembered me. Smiling weakly at me he said,” what are you doing here this late?” I told him that i was covering the ward tonight and heard that he’d been unwell so i swung back to have a look at him. Told him what my plan was for him. “More needles hey. Sigh. Maybe it will finally stop when im gone”, he said softly. 

I kept quiet. Deciding the best way to approach this knowing that I can’t possibly say anything to make him feel better. We are all very aware of his slow and painful final journey. I looked over at him, he had his eyes closed eyebrow furrowed. I made the executive decision that quiet was the way to go. So i focus on finding a vein which he hadnt had that many left. The only left were either too small or too deep.

His breathing slowed and he started talking to me again. “Im just glad that my wife isnt here right now. It’d break her heart. ” I cleaned his skin thoroughly and said gently “sharp scratch now, my dear.” As i slowly advanced my needle i replied him, “Now my dear, you have to tell me how did you meet your wife? How did you get such a beautiful soul to marry you.” 

I wasn’t getting much of a headway with his blood. The vein was so small i had to adjust my needle to get good flow. There was silence followed by a small chuckle as he recounted how they had met. “She’d argue with me about this but she made the first move.” Blood was trickling slowly by surely. We needed >20mls so I held the needle steady in one hand, with the other hand i had to very carefully aspirate the syringe. 

What i didnt know was that i was in for a lesson 101 in relationship and love. “Love is hard work. Do you have a special someone?” He probed. 

“Yes and no? I think do have someone special but i just dk if he thinks that im special.” 

“You dont think you feel. What does your heart tells you. Is he special yes or no? Your answer shouldn’t be dependent on what he feels. You should always know your heart first.” 

Stunned by his question. I said,” yes” without thinking. He continued, “ love is hard work with a lot of inner growth. Difficult conversations. But you should never had to doubt where you stand w this person. Do you know where you stand?”

“Needle is coming out. You did extremely well, hun.” I said as I retracted the needled and put some pressure on the area. I was so relieved that we managed to get enough blood. 

I looked up and there he was, just waiting for an answer. “ i dont know.” 

“Have you spoken to him about it?”

“Nope.”

“Why?”

“There isnt a right time or place.”

“All i hear is excuses” 

“Excuse me sir. How did this conversation turn to me? All i wanted to hear was a once in a lifetime romantic story. Although, im extremely glad that you have regained some vigour in your voice.” I chided gently.

“It doesnt exist. True love, healthy relationships and romance is what YOU make of it. Love is a choice. Do you still not understand? It takes mutual effort and a lot of hardwork.”

“Just because you choose someone doesn’t mean they will choose you.”

“You are still not getting it. You have to choose him with your heart. To love fully. Even if he doesn’t reciprocate you’d know you gave it your best shot. Then move onto someone better who is more deserving of you who isn’t afraid to love you for you flaws and all.”

“But i dont know how to love tho. I dont think i can.”

“You give love everyday. To everyone. You sat with me that day not saying a single word and just kept me company. You gave your precious time despite being busy. Thats you giving love. Thank you for being there.”

“I just wanted you to know that we care.” 

I turned my back towards him. Fought back tears. Patients do know when someone cares. I hope Mrs S knew that i truly did care for her. I was rooting so hard for her. Getting so emotional today because Mrs S in that corner room had just passed away and i hadnt had time to even process or grief because i had to see him. My heart was weighing so heavily. Im about to ugly cry in this terminally ill patient’s room. What on earth am i doing? I am supposed to be the sunshine and warmth to my patients. I am supposed to be strong and assume a leadership role infront of them to incite confidence that we are doing our absolute best for them. So i forced down my emotion and nausea. 

We kept pleasant silence as i prepared the blood cultures tube. Mainly because saying even one word in my state will be enough for this freaking tear duct dam to be unleashed. 

“ I know you will find it. The person who will understand your silence. Be your pillar. See beyond the facade you put on everyday. We all have that facade that we shed when we are infront of the person we love the most. You just need to believe in yourself. Dont lose that warmth or that bedside manner.”

I smiled at him,” thank you. I will deeply reflect on your words. If you start feeling unwell please let the nurses know. I will come running back for ya.”

“Come running back for me. And you say you cant love.” 

I left the room. Sent the blood. Sat in the office for 10 mins to recollect my emotions.

Then i went to certify Mrs S. As i walked towards her room. Family members were coming out. I detoured to the exit because after 8pm we need to tap visitors out. I held the door open as they walked passed me one by one. Tears streaked faces but never forgetting to thank me. My chest tightened. When they left, i went to her room. 

From the end of the bed, was the same frail old lady. Now lifeless. No more constant beeping of machines. Total silence except for my own beating heart. I did my routine of introducing myself. “Hi, Mrs S its me Jia. I saw you last night. Im just going to have a look and listen. I apologise in advance.” Then I settled into my usual routine of certifying death. Warm hands now cold. 

Cold lifeless hands always fucks me up. Because i always make it a point to hold my patients’ hands. So the stark difference always breaks my heart. I ended by saying, “You’ve lived hard and well. You were well loved. May you rest in peace.”

I left her room. A little more broken than i am already. 

That night, i went home and cried for the longest time. I cried over my interaction with Mr M. I cried for Mrs S and how she never managed to see her husband for the last time. I cried for my bruised heart and inner child who is still ever so afraid of love. I need a hug.