When doing more than necessary is the right thing
Runner-up in Pulse’s 2015 writing competition, Dr Claire Davies
Death’s rattle was audible even before I walked in. The woman lay on the bed, legs tangled in the sheets. I could sense her fever without a thermometer, and see the depth of her coma without shining a light in her eyes. On the table, there were photos of family groups reunited. A boy peered around the doorway, holding a radio blasting out rock music.
‘Turn the music off, son,’ I said.
The woman’s husband sobbed into a rosette of toilet paper bunched in his fist.
‘Is this normal?’ he asked.
The woman was 31 years old. The call had come to the out-of-hours base: ‘Breast cancer with liver mets. Now unresponsive,’ said the screen.
The husband had refused to call an ambulance, claiming she might catch cold. Her chemotherapy had finished just six weeks before. ‘Chemiotherapy,’ he had called it. There was supposed to still be hope. I had gone to the car. The driver took us past battered pre-gentrification shops piled with yams while I thumbed the faded A to Z. At last we arrived at the estate. I struggled up to the fourth floor with my bags into the over-heated flat, its moist cooking smells grasping me around the throat as I walked in.
Other writing competition entries
(2nd place) Dr Ellie Cannon: ‘Why hold back the tears?’
(3rd place) Dr Roger Henderson: ‘A presumptive diagnosis’
(Under-35s winner) Dr Ahmed Rashid: ‘The famous razor of Occam’
I felt slightly panicky when I saw the woman, feeling conscious of everything I lacked. No medical notes, no knowledge of the family, no security of a hospital ward where others might share the load. My instinct was to put my arms around the husband, but professional boundaries held me back. Besides, I had a question.
‘If something happened…,’ I said, fumbling for words. ‘Let’s say she stopped breathing, for example.’ I paused to let the words sink in. ‘Have you talked about what you wanted to do?’
The man sobbed even louder.
‘I want everything done,’ he replied.
Resuscitation – tubes and masks and the feeling of ribs cracking beneath hands. It seemed an undignified death, but each futile breath blown into the congested lungs bubbling with secretions might offer a last ray of hope.
If I did nothing and kept the woman comfortable to slip away at home – well, the family would remember me as the person that came and did nothing. They needed time to prepare themselves for the inevitable – to feel like everything had been done. For the first time, I became aware of those occasions when you need to do more than is necessary, particularly when the patient is young.
The woman began to wheeze. Her unseeing eyes opened with the force of agitation. The man stepped forwards and spoke to her, looking for a response but there was none. Above the bed, a picture of the crucifixion stared at me accusingly.
I picked up the phone and dialled 999. Holding the man’s hand tightly, I prayed that the ambulance would arrive soon.
Dr Claire Davies is a GP and blogger from London