It’s one of the last calls of the year but no matter how hard I try I can’t track down the family. Every couple of weeks, I dutifully dial the numbers written on a scrap of paper that I carry in my bag. Sometimes I call one child, then another but the phone rings out. The thought crosses my mind that perhaps the time has passed to offer my condolences and that a call from an oncologist is not the way to end a bad year, but something tells me to keep trying. When long-term patients die, both parties seek closure. Finally, someone answers and my heart floods with relief.
My initial impression was that between her other serious health problems and cancer, she wouldn’t live long but she happily defied my prediction. We knew she wasn’t going to get better but still, her life had meaning.
During the height of the pandemic, she became unwell and reluctantly landed in hospital under a different team. Amid a severe lockdown when no family members were allowed to set foot inside, the hospital became a prison for patients, trapped with their worst thoughts and fears. Slow to follow English, she needed time and patience to elicit her symptoms. Sadly, time and patience were in short supply as hospitals struggled to replace staff revolving in and out of quarantine. I visited her when I could, reassuring her that her latest problems were resolvable.
On the weekend, she was comfortable, but I could sense the cloak of loneliness that surrounded her, and my heart ached to get her home. One more day, I bargained, to be sure she wouldn’t bounce back. If you think it’s best, she acquiesced.
In a maddening vagary of the hospital system, I only found out that she died in hospital when she didn’t attend my next appointment. In the span of my career, some cancers have become curable, but we still lack a system that will notify doctors when their patients have died. Relying on death notices and the goodwill of relatives is inadequate and unfair. Dismayed, I combed the notes for information but when cancer patients die, their notes can be objectionably brief, as if everyone was just waiting for the event.
This phone call is my opportunity to find out more. Her eldest daughter starts by saying she can’t sleep at night knowing that her mother was in pain. Surprised, I reassure her that in all the times I checked on her, she had never reported strong pain. It’s tricky to assuage this grave fear without sounding dismissive but I press on because of all the reassurances relatives need, the most important is to know that their loved one did not die in pain. It takes me some effort but I make good gains.
Next, it’s another daughter. “What did she say to you?”
“I know that she missed you very much and was looking forward to going home. I am sorry it didn’t happen.”
The daughters had begged and begged to see her, declaring that they were ready to “get the virus” if it meant setting eyes on her. Desperately, they wanted to sign a declaration to absolve us if they contracted Covid but of course, there was no such form and no such dispensation. No visitors were allowed, and it fell to doctors and nurses to dispense the punishment and handle the devastation.
“I want to know how she died,” the daughter says.
“She died comfortably. Her body grew tired.”
She is not satisfied.
“I want to know what she said to you. Was she calm? Was she conscious? Did she give you a message?”
The recognition hits me like a rock. She thinks that I was with her mother when she died. After all, why wouldn’t she? She has seen the images of professionals connecting patients to their loved ones via FaceTime, holding the hands of the dying and relaying their last words. But alas, those patients were in the minority. My patient was one of many who died alone. There were just enough people to meet her medical needs but amid the chaos, satisfying spiritual and human wants was a luxury.
With a lump in my throat, I ponder the enormity of what I am about to reveal. There is no sensitive way to destroy her belief that if her family couldn’t be there, at least the oncologist she liked and trusted bore witness to his last moments. What would she say if I told her that I didn’t even know she died until a week later?
“When your mother died, I’m afraid I wasn’t there.”
That one word contains a universe of dashed hopes.
To her credit, she recovers and thanks me. I commend her for her forbearance and strength. By the time we end, our exchange has been mutually cathartic.
This Christmas, there will be many families like this with an empty place at the table. Their loss will be especially painful because the pandemic forced a cruel separation at the time of death. I realise that relatives who could not even give their loved one a proper funeral find it hard to be consoled by the knowledge that the lockdown contained the virus and protected the broader population. I supported the lockdown but also struggled with the consequences for my patients. Indeed, for many frontline workers, the hardest part has been watching the public health interest clash with deeply human needs while appreciating the role of each.
For some relatives, the rules eventually relaxed. For others, it was too late. Many grieving relatives will continue to ask, “Could we just have said a final goodbye?” We can’t dismiss them or pretend to know how it feels to be in their shoes. The least we owe them is our understanding and empathy for their sacrifice and a renewed pledge to do our part so that no family may have to repeat their experience.