at the heart of it

"Oh, I would just like to go quietly. Peacefully, you know?" Her powdery round face in its wrinkled beauty purses its lips and continues its laboured exhalation. "My husband disagrees, though. He wants me to be resuscitated, and to go on a breathing machine." Her fast, irregular heart rate pings up and down on the cardiac monitor, and I envisage her soft, floppy heart, straining to pump blood into soggy lungs, and thereafter round stiff arteries. She grips the rails of the bed. The papery skin of her hands are pockmarked by the numerous attempts at trying to find a vein beneath her fluid-loaded tissue. She smiles, and looks unafraid, and I make a mental note about how her ongoing care wishes can be sold to a medical team. I marvel at her peacefulness as I ask her difficult questions, and I'm frustrated at the bartering that will need to take place to ensure that this lady receives the most appropriate level of care to meet her end of life expectations. Her blood results indicate she has not been taking some of her myriad medications, and I wonder if the wily old soul has been trying to expedite this moment, in a way which obfuscates her poor husband's responsibility. This husband who has probably lived with this gentle lady since somewhere between Marilyn Monroe marrying Joe DiMaggio, and the release of A Hard Day's Night. For him more than her, separation and loss are the darkest clouds on the horizon.

"Do you have any pain in your chest? Do you feel anxious about your breathlessness?" I do the doctor thing, simultaneously weighing up her symptoms, and trying to address what is actually bothering her at that moment in time. One thing I have learned in this job is that people present not with a clear list of symptoms, but a muddled collection of anxieties and worries and questions and complaints, sometimes among which lurks identifiable, concrete pathology doing its best to evade detection.



But at the heart of it is a lady in her ninth decade, probably taking a calculated decision to avoid most of her twelve or thirteen medications set out for her in a neat pack day-by-day, and seemingly with a penchant for avoiding any more trips to hospital to be needled and prodded and carted around in ambulances, to be told once again to go home and take her tablets. We recognise her wishes, and encourage her to discuss advanced directives with her husband, to help us facilitate her comfort and wish for quiet at this, the encroaching interminable advance of time.

I am not interested in commenting on the rights or wrongs of how we treat (over-treat, under-treat) in our lavishly rich medical systems. I am interested in one old lady and her clear-sighted wishes about her own ailing body. Individuals at the bottom and the top of our society, are also at the centre.