We received more than 50 excellent entries for our writing competition, and we are now ready to announce our winner. Our judges said that Dr Paul O’Reilly‘s reflection on his duty of care and candour on a patient’s final birthday was incredibly powerful, combining a touching patient story with a real moral dilemma. As a prize, Dr O’Reilly will be Pulse’s latest blogger!
‘More birthday cake, Doctor O?’ asks K with a shy pride.
‘Yes of course,’ I answer eagerly. It is the practice manager’s chocolate cake and she bakes well. I take the large slice she hands to me, trying not to get any more crumbs over the sheets on the edge of her bed where I am sitting. Her nurse has already commented on this.
K beams with pleasure at her unexpected birthday party. Around her hang the decorations, balloons, paper streamers, flowers and all kinds of other stuff the practice manager has brought to hide the drips, syringe drivers and beeping machines.
An hour ago, when we came, I was shocked to see her; frail, weak and clearly within the last day of her life. But she is being well nursed. She is calm and pain-free on the usual palliative care drugs. She has been able to speak, via the practice manager’s phone, with her children and grandchildren in Austria who have not been able to come to see her before she dies. Now, we sit quietly with her, as she talks openly about them for the first time.
She has spoken only briefly of her grief at dying prematurely at 59, alone in a foreign country where her presence has never been legal. And she has mentioned her regrets and shame about her drug use. But mostly, we keep it positive by speaking of her children and grandchildren, albeit far away. That is her ultimate contribution to the world. Her husband is not spoken of, apparently medicating his grief on a bottle of vodka a day plus heroin and crack. On the few occasions we have managed to contact him, he is manifestly intoxicated and oblivious. She was his anchor and he is now adrift on a flood tide of booze.
But the cake does not taste well in my mouth. In my heart I know that I am lying to my patient in our last moments together. Somewhere in another hospital is the doctor who, despite all the indications of serious disease, simply discharged her five months ago after an episode of acute retention with an indwelling catheter and a vague promise of follow up sometime. It seems he never read the report of the MRI he ordered, which showed a large mass on her bladder and suggested that it could be cancerous.
Conscious of the amount of glass in my own house, I am not much given to the throwing of first stones, but nothing in my entire career has made me more angry with a colleague. When I have calmed down, I will ask the hospital to investigate the sequence of events and learn lessons for the future. For now, it seems just a little too recent and raw. By my duty of candour, she should know this last fact about her life. But I would lose a limb rather than cloud her quiet eyes on her last birthday.
It is time to go. I press her hand one more time, but there is no response. She is asleep, a sleep, from which we had both known she would not awake. I do not know whether we shall meet again. And if we do, I do not know whether she will thank me for my decision. But I hope that she will know that I decided with only her in mind and care for her in my heart.
Reader, please tell me if I did right.
Dr Paul O’Reilly is a GP partner in London
Dear Paul – how incredibly moving.
You did it right..
yes you definitely did the right thing. so nice to hear a fine example of patient centred care….
You for right. Thanks for sharing this
Thank you, Colleagues