The generosity of patients reminds doctors of our shared humanity | Ranjana Srivastava

When doctors receive notes of thanks, we’re mostly floored. These acts of kindness speak to us of empathy, compassion and humility

On her way to hospice my patient had one last thing to take care of. She has had a difficult time for the past several years culminating in such an aggressive and visually distressing recurrence that even she says she had had enough and just wants to die. She remains at home for as long as she can, receiving visitors and cherishing her grandchildren, until it’s just too hard. Then, graciously and calmly, she submits to hospice, and along with it, the truth that these are the very final days of her life.

Sometimes, she reminds me of the feted neurologist, Oliver Sacks, and the grace with which he faced the end of his life – except she would laugh at the comparison, calling herself an ordinary woman who had worked hard, reared two wonderful children, and just as she felt she had acquitted her roles, lost the lottery to cancer.

The last time we met, she was breathless, uncomfortable and fatigued. But her face shone with a rare dignity. She told me that while she wasn’t afraid to die, she grieved for her son who was disabled and depended on her for care. I understood immediately that her greatest worry was his welfare upon her impending death. Her daughter sat next to her, outwardly calm, but her expression reflecting private horror at the prospect of losing her mother and becoming the sole guardian of her brother, while fulfilling the usual responsibilities of work and motherhood. Even in a clinic where sadness reigns, their story moved me greatly and I wanted desperately to help.

“I feel as if there’s nothing I can do for you personally but I’m going to see about your son,” I said, unable to keep the defeat from my voice. I promised nothing and she expected nothing but by luck, a phone call explaining the urgency and pathos of the situation helped decisions that would have happened anyway. But it meant that in the final days of her life, a mother knew that her child would be safe.

“Fragile”, declares the sign on the box resting on the floor as I enter my office. Curiosity takes second place as I gently move it out of the way so it’s not a tripping hazard. The intervening hours are taken up by ill patients and it’s not until a receptionist reminds me that I think to open it.

Behind layers of beautiful wrapping there lies an exquisite edible tree. Luscious strawberries hang on branches, coated in delectable chocolate. A star-shaped piece of pineapple sits atop the tree. I stand still, catching my breath at the work of art. A small card nestles at the base of the tree. I detach it, careful not to disturb the branches of the tree. The card reads simply, “Thank you for looking after our son and brother.” My throat catches. Having underestimated her panic, I had clearly also underestimated her subsequent relief.

I call her at the hospice. The nurse, initially sceptical, puts me through. She speaks slowly, breathlessly but that she is thrilled at my pleasure is apparent. I don’t know how to say that I am particularly moved to be in her thoughts at the end of her life, when typically, the oncologist is thought to have failed, but she fills in the silence with a firm instruction: “Listen, take this gift home. I want your children to know what you do and just how much you are appreciated.”

Upon hearing this, I am suffused by a type of survivor’s guilt. All this for doing my job? For moving a small piece of a giant puzzle? I can’t even say I will see her next week or next month. Instead, I reassure her that she is in good hands. And I drive home slowly, taking care to not topple my gift.

The philosopher Seneca remarked, “What need is there to weep over parts of life? The whole of it calls for tears.” A career in medicine can feel like that, amid the pressures and politics. Each day is a scramble – the healthiest patients protest; the sickest suffer quietly; the neediest don’t even recognise their need.

The funding is never sufficient and the bureaucracy is never efficient. Just like in other aspects of modern life, it has become customary to be at the mercy of the cynical message that says medicine has become entirely transactional, that doctors don’t care for patients like they used to and patients don’t respect doctors like they used to. But just as this cynicism threatens to vanquish you, you realise that the beauty and wonder of the doctor-patient relationship is actually alive and well, manifest in the most unexpected encounters.

It’s fairly common to hear stories of doctors who go beyond the call of duty to help their patients but if I have learnt anything from being a doctor, it’s the way in which patients impel doctors to realise the better angels of our nature.

If I were to name one attribute that trumps fear in a cancer clinic, it’s generosity. Just as you thought there couldn’t possibly be room in a patient’s heart for anything other than the most urgent of needs, there arrives a card in the mail, the photo of a longed-for baby, a letter of appreciation, or sometimes an edible tree that says thank you for looking after me, thank you for accompanying me on my journey of terror, thank you for being you.

Mostly you’re floored, knowing full well that much of a patient’s outcome, excellent or awful, depends on biology, environment and a whole lot of factors beyond the control of your prescribing finger, but you can’t help admiring the character of people who, even when they are dying, spare a thought for someone else. It’s not that these acknowledgements make us feel more important than that they remind us of universal experiences and shared humanity. They speak to us of empathy, compassion, and humility, not as the exclusive domain of the doctor but indeed, flowing in equal measure towards the doctor.

My edible tree comes home and is greeted with gasps of wonder and squeals of delight that must surely be audible to my patient. Read the card at least, I say, but my children are too busy. The strawberries are picked and the chocolate licked. The pineapple star is evenly divided. For a long while there is only the sound of contentment until someone finally says, “It must be hard work to earn these chocolates, well done!”

I think to myself that somewhere in her sleep my patient must be smiling, knowing that her wish had been fulfilled.


Ranjana Srivastava

The GuardianTramp

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