Was he waiting for his brother to come and visit him?
Despite trying his best he couldn’t come as his visa was not granted. The best they could do was to arrange a goodbye via video call. Not in any way a replacement but better than no contact at all. The too common experience of extra suffering caused by geographical distance. The brutal trade-off that all immigrants have to face when they leave home. They move in pursuit of a better life for themselves and their families. The costs of separation might have been considered but do not sink in until tragic events occur. An ocean away can feel like a galaxy away. The unfulfilled wish of being there in a time of need. Reunions depend on the whim of bureaucrats who, at times, are felt to be heartless, lacking in empathy and disconnected from the human race.
What was different in the past week? How did he hold on? Why?
During his dying phase, he had spent more time with his ex-wife and daughters, than he had in many years. One of his biggest regrets was not spending more time with them before he had become unwell. The events preceding the divorce had stuffed it all up. During his final admission, there was always someone staying with him, 24 hours a day. A sensible roster had been set up between his wife and daughters as they held their combined vigil. Was he trying to extend his precious time with his ladies for as long as possible through sheer willpower? Maybe. He was beyond asking. We could never know for sure.
He died last night, in the presence of his family. He had outlived our prognostication by many days.
Life can be full of uncertainty and the same is true for dying. When will it occur? The doctors don’t really know, they can only give their best guess. The ones who give an exact time are likely out of their depth and answer with false confidence. Three weeks. Three days. Three hours. Medical science is not that exact yet. Maybe someday there will be a test that will tell people exactly how long they have left to live. Not available yet.
Sometimes people will say their goodbyes too soon. They carefully choose their words as it might be the last time they ever see each other again. Could it be the final farewell? Yes, it could be. We’d better say what we really need to say just in case it is the last chance we ever get. A final chance to connect with a loved one. A final chance to heal or to hurt. A final chance to say what a person means to you. A chance to wish them all the best for the future you won’t be a part of. A final chance to share one last rendition of a long-standing private joke. One last hug. At least you had a chance to see them before it was too late. Not everyone makes it in time, which has been particularly painful in these COVID-affected years. So close, but yet so far. So much suffering.
Why do we leave things unsaid until we know a person is dying? Could we have told them the truth earlier when we were both fit and healthy? All of us who live will at some stage die. It could happen to any of us, not everyone gets the chance to say goodbye to the important people in their lives. Sudden deaths can happen without any warning. Accidents happen all of the time through no fault of anyone. What would you regret not telling someone today, if you were to die tomorrow? Death could happen to any one of us, at any time.
If you both can still see each other the next day, consider it a bonus.
How much is enough? This is a question not asked often enough of ourselves.
Many of my patients had been saving their fun times, their big and only overseas trip until their retirement. I’ve witnessed many tragedies as people retired and become unwell. The opportunity to enjoy their hard-earned reward stolen from them by illness. Falling unwell soon after retirement. Going from the working life to the dying life within a matter of months.
Balance must be sought and acted upon. That’s what my Aunty Helen always tried to teach me. It is good to scrimp and save but enjoy yourself along the way, as you may never get the chance to. I’ve seen it in the stories of the patients I look after. They saved up all their enjoyment until the end but were too unwell to enjoy anything.
Working in palliative care you’d think we’d learn the lesson – life is too short. Seeing this stark reality daily through others’ experiences could act as a stimulant to action. Often it doesn’t, we practitioners are just as human, just as blind as everyone else. It won’t happen to me. I’ll be one of the lucky ones. But it could. Happen to anyone.
Are you still working towards your goals and values? Are you being true to yourself and your life mission?
How much is enough?
It depends on who you ask, everyone will have answers which match their bespoke lives.
He had moved over to New Zealand because of the Lord of the Rings Trilogy. He had loved the scenery in those movies and had wanted his son to grow up in the country that the films had been made. They’d moved over six years ago, and had worked hard since arrival, building a better life for themselves.
He and his wife were high school sweethearts, they were also University classmates and after graduation they had married. Their son was now 10 years old. They had settled in Auckland and devoted a lot of time into growing their own demolition business.
Their idyll was smashed by the wrecking ball of illness when he suddenly had a seizure. He couldn’t remember what happened but it had been frightening for his wife and son. He regained consciousness in hospital and bad news was related to them. He had a mass in his brain. A scan of his body revealed a lung cancer. He didn’t smoke, and had no family history of cancer. Bad luck had brought cancer into his life, and it had spread aggressively to his liver, to the other lung, and into his brain causing the seizure. It ignored his behest, “You shall not pass!”
He talked about his regrets. He had moved thousands of miles away from his family in Asia, all the way to this country with the beautiful scenery. They had worked so hard that they never had time to leave Auckland, he had barely crossed the Auckland Harbour Bridge. He had never seen in person the spectacular vistas that had drawn him and his family over. He wished he had spent more time with his only son. He knew that he would be leaving his wife soon and she would have to raise their boy alone, that nothing could stop him from dying.
Agonised tears flowed like the waters of the Tawhai Falls, where Gollum was filmed catching a fish, another place he never had a chance to visit. His desolation much worse than any a dragon could’ve wrought.
You’d think that we know this all too well working in palliative care/hospice but we are just as human as everyone else. We also get lost in the busyness of life in general. Rushing from one appointment to the other and having to switch roles as seamlessly as possible. I am no different to anyone else. I don’t have all the answers and am still searching for them myself but I want you to have a think about some questions I raise below.
Life is too short could be a stimulus to reflect on how you spend your time. Are you in a job that you actually enjoy? Do you feel like you are making a difference. We spend a lot of our time at work, 8 or more hours a day, maybe for 40+ hours a week, month after month, year after year. A big chunk of our lives is spent at work, and you may be spending more time with your workmates than you spend with your own loved ones, friends, and family. Are you happy at work or is there something else you’d rather do, somewhere else you want to be? Does it still satisfy you professionally? Are you finding yourself enjoying what you do or do you find yourself putting up with things? What would be your outlook on your job if you only had 10 years left to live? These are questions that we don’t ask ourselves, but are situations that my patients have found themselves in.