Nearing the end of his life, a patient tells me, “If you should ever need it, I hope your doctor is as good to you as you have been to me.”
It is an unusual benediction.
Honouring our long association, I have dropped in after hours when crisis befell and had difficult conversations with his wife, not to mention with other doctors, to say that sometimes “best interest” means allowing someone to die. Now I sit at the foot of his bed one last time but I can’t imagine any doctor thinking these are “favours” rendered to our patients; they are, simply, the bread and butter of good medicine.
He drifts off to sleep before I can tell him that I have already experienced my share of life-altering generosity from a doctor.
The beginning of my motherhood was marked by the sudden loss of a previously healthy, midterm twin pregnancy. Destiny knew how to deal a swift blow; I was pregnant on Monday and not pregnant on Wednesday. The following week on ward rounds, my gravid abdomen continued to attract my elderly patients who desperately missed their grandchildren. When was I due? Was this my first? Boy or girl?
I did not have the heart to puncture their joy, instead saving my anguish for the bathroom, willing my body to shrink back to size. In an act of defiance, I tossed out my vitamins, cursing those translucent pills for the telltale “glow”.
Despite it raining kindness, I felt stranded in my grief. Betrayed by God and body, I was too young to know the universality of suffering. I was also troubled by an existential question: if a mother was said to be only as happy as her unhappiest child, where did this leave me? Did the dictum apply to all pregnant women or only those who successfully gave birth?
More used to giving care than receiving, I turned against myself. Recalling the plight of my patients, I thought my sadness self-indulgent, much to the dismay of my social worker friend who encouraged me to democratise my grief and let people in. But still in shock and surrounded by pregnant friends, I didn’t know how.
The smooth half of my pregnancy occurred in the United States where I had been completing an ethics fellowship. In Australia I had just met the obstetrician undertaking the fateful scan. He was reflecting on his career until he pushed the probe so hard that I jumped. A tense hour followed. Then, hushed consults just out of earshot, an urgent amniocentesis, and the summoning of “foetal sub-specialists”, a specialty I didn’t even know existed.
After wiping rivers of gel from my abdomen, the obstetrician escorted me to his tiny office. As he explained the physiology of in-utero death, I couldn’t help marvel that in another world, this would have been a great tutorial. When I looked up, I noted his tears; I would save mine for the car.
Pregnancy and funeral over, I held out for better days and congratulated friend after friend having babies.
One afternoon I received an elegant envelope. It was not a bill or a fine, not even a reminder to renew a medical journal at an “only for you” price.
Dear Ranjana,
I trust you are coping okay after the very sad events of recent weeks.
My eyes dashed to the end to find my obstetrician’s signature.
It must have been so hard.
I tensed at the memory.
After all the initial good news, to walk into our scan room and be hit with all my news must have been unbelievably tough.
This simple observation brought me undone, written by the one person who bore witness to the precise moment my life changed. This, from the doctor taxed with diagnosing a fatal condition and delivering the bad news without preparation. Who had struggled to contain his own emotions as he tried to anticipate mine.
I read and reread the letter, letting the content sink in. All this time, I had struggled to take the measure of my own grief. Caught between the instinct to mourn and the urge to forget, I had dismissed weird dreams of dead people and attempted to minimise my loss.
Not to mention taught myself to be grateful that what happened to me happened in a big hospital in a rich country because we all know how much messier the outcome could have been.
Amid these warring thoughts about the “right” response to my situation, the letter from my doctor landed like a permission slip. If he, armed with a lifetime of experience, had deemed my situation tough, maybe it really had been so. In naming his own sadness, he had validated mine. I felt seen.
Hopefully, we will meet again under more positive circumstances.
How much I wanted this, too.
I thought that I had lost the letter but last month it fell out of one of my old journals as I rearranged my collection.
A full 18 years later, his words still pull me short. More poignantly, their timeless empathy moves my three healthy teenagers now old enough to appreciate why kindness matters.
Through a mutual friend I reach out to the obstetrician to say thanks, not expecting to be remembered from the thousands of high-risk patients. But I should have known that our “worst” cases have a way of remaining with us.
When we meet he remembers the day and his sadness as clearly as I do. I finally have a chance to tell him that the decisions he made on the spot went on to shape my entire approach to patient care.
Health professionals begin a new year with a lot to take stock of since healthcare crises just seem to roll into each other, creating a familiar fatigue. Many problems are systemic, requiring better resourcing in the right places and more far-sighted decisions.
But I can’t help thinking that at least some of the problems our patients face don’t need more money, technology or beds – they simply require us to use our moral compass.
When my doctor could not save my pregnancy he did the next best thing: he chose to be kind and made a difference that still ripples in my life.
I could live by this creed.
