She was unwell, and needed to come in for symptom control. She had been sick for many months but the pain had worsened to the point of intolerability. This was one tough lady, and she liked to show just how tough she was by being in your face. This is how I am, and who I am, and if you don’t like it, go to hell. That’s what her outer shell showed anyway, when she arrived she was feeling too unwell to put up her usual shields. She had always had trouble letting people in, and it took a bit of work in order for us to establish an useful rapport with her. Once we did we were able to help with her physical symptoms but no matter what we tried we could not penetrate her deep sadness and her feeling of being unloved.

She had moved thousands of miles from her birthplace, away from her blood family members. She had made a new life for herself over the 20 years that she had lived in New Zealand, but it was away from her family of origin. There seemed to be something from her past that kept on hurting her, even more than her end-stage cancer was able to. Physical pain we managed to get on top of, but her emotional pain we weren’t able to shift at all. Our counsellors, social workers and spiritual care advisor all tried their best but something was held back, which she could not share. Some things just hurt too much to be revealed, even to total strangers.

At the end of her week she had visitors arrive from overseas, her sister arrived from Australia. A sister that we had never heard of, until she had arrived at our doorstep. Followed a few days later by two sets of parents. Her mother and her partner arrived, followed closely by her father and his partner. Her parents had divorced before she had moved to New Zealand. Her family had traveled to say goodbye to her. Over the course of the next days she seemed to be lighter in spirit, some of the anger, hurt and resentment seemed to have disappeared from her face. She appeared to have found some inner peace that had always been missing.

She had not been close to her family since leaving South Africa, her mother and sister had visited her a number of times, but her father had never done so. She was her father’s daughter and never let on to him how much she missed him, how much she would’ve enjoyed him visiting. She wished that he had come sooner, and not at the very end of her life, when it was almost too late.

He was his daughter’s father and similarly had never revealed to her the real reason that he had never visited. It wasn’t because he didn’t love her, and didn’t want to see her, he did love her and he did miss his youngest, his Daddy’s girl. He couldn’t put aside his macho Afrikaaner personality even for an moment in the previous 20 years to admit that he had a life-long severe phobia of flying. That’s why he never traveled outside of South Africa, because he could not fly because of paralysing fear. To make the journey to New Zealand to say goodbye to his daughter he had been prescribed large doses of sleeping medications, which he needed. He had to conquer his worst fear in order to see his little girl for one last time.

Two people trying to stay tough and not reveal their fears and vulnerability had robbed each other of a loving relationship. They spent a week getting to know each other again, healing their long broken relationship. That’s what we saw happen, the shadow leaving her. She said goodbye to her mother and her partner who were heading back to the United Kingdom. Her father and his partner then left for South Africa. Her sister was still here the next day, when she had her final deterioration. Overnight she had suddenly changed, and by late morning she had died, peacefully, comfortably and in a healed state.

Lesson learnt:
The importance of communication between clinicians and patients, but also between family members comes to the fore. Is there any unfinished family business? Sometimes we are surprised when suddenly people mention long lost sisters, brothers or even children at the very end of life. We may have known these people for weeks, months and they had never mentioned their lost ones. Many people may have skeletons in their closets.