By Rachel Clarke
Dr. Clarke specializes in palliative care with Britain’s National Health Service.
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| Ariel Lee |
A furrowed brow
and flailing arms were all we had to go on. The grimacing, the way the
patient flung his head from side to side — all of it signified an
unvoiced anguish. We tried talking, listening, morphine. His agitation
only grew.
All cancers have the power
to ravage a body, but each assails in distinctive ways. One of the
particular cruelties of a cancer of the tongue is its capacity to
deprive a person of speech.
Some of
us thought he must be suffering from terminal agitation, a state of
heightened anxiety that sometimes develops as the end of life draws
near. But the junior doctor on the team, Nicholas, was convinced that we
could unlock the source of our patient’s distress and volunteered to
stay behind in the room.
Nicholas reappeared about an hour later. “You can understand his speech,” he announced. “You just have to really listen.”
When I re-entered the room, the
reclining chair that the patient — a tall, angular man in his 80s — had
been thrashing around in had been turned to face out onto the garden and
the double doors were open wide. Now he sat calmly, transfixed by the
trees and sky. All he had wanted was that view.
For
a decade, I have worked as a doctor in Britain’s National Health
Service. We are an overstretched, underfunded health service in which
too few doctors and nurses labor with too few resources, struggling to
deliver good care. Burnout among staff is endemic, so much so that it
threatens to stifle the kindness and compassion that should be the
bedrock of medicine.
But then there are the moments when helping someone is easy: Just nature is enough.
Before
I specialized in palliative care, I thought the sheer vitality of
nature might be an affront to patients so close to the end of life — a
kind of impudent abundance. And yet, in the hospice where I work, I am
often struck by the intense solace some patients find in the natural
world.
I met Diane Finch, a patient,
in May, on the day her oncologist broke the devastating news that
further palliative chemotherapy was no longer an option. She was 51.
From that point on, her terminal breast cancer would run its natural
course, medicine powerless to arrest it.
“My first thought, my urge, was to get up and find an open space,” she
told me on that first meeting. “I needed to breathe fresh air, to hear
natural noises away from the hospital and its treatment rooms.”
At first she
fought to preserve herself digitally, documenting every thought and
feeling on her computer before they, and she, were lost forever. But one
day, as she was typing frantically, she heard a bird singing through
her open window.
“When you come to
the end of your life, you get the sense that you don’t want to lose
yourself, you want to be able to pass something on,” she told me later.
“When I had whole brain radiotherapy, I felt as though something had
dropped out, as if everything I said needed to be saved. It was all
running away from me.
“Somehow, when
I listened to the song of a blackbird in the garden, I found it
incredibly calming. It seemed to allay that fear that everything was
going to disappear, to be lost forever, because I thought, ‘Well, there
will be other blackbirds. Their songs will be pretty similar and it will
all be fine.’ And in the same way, there were other people before me
with my diagnosis. Other people will have died in the same way I will
die. And it’s natural. It’s a natural progression. Cancer is part of
nature too, and that is something I have to accept, and learn to live
and die with.”
Ms. Finch recorded a
song based on the peace she felt listening to the bird song, and it was
enough to bring her some relief from what — up to that point — had been
almost feverish efforts at self-preservation.
Another
patient, whom I admitted in July with about a week to live, was mostly
concerned that I keep the windows open, so that he could “keep on
feeling the breeze on my face and listening to that blackbird outside.” I
rushed to make sure of it.
Shortly before his death from pancreatic cancer at 59, in the 1990s, the British playwright Dennis Potter described the exaltation of looking out at a blossom that had become the “whitest, frothiest, blossomest blossom that there ever could be” from his window.
“Things are both more trivial than they
ever were, and more important than they ever were, and the difference
between the trivial and the important doesn’t seem to matter. But the
nowness of everything is absolutely wondrous,” he told an interviewer.
People
often imagine hospices to be dark and dismal places where there is
nothing left to experience but dying. But what dominates my work is not
proximity to death but the best bits of living. Nowness is everywhere.
Nature provides it.
Rachel Clarke (@doctor_oxford) is an N.H.S. doctor and the author of “Your Life in My Hands: A Junior Doctor’s Story.”
Full Article & Source:
In Life’s Last Moments, Open a Window
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