1. Setting up the interview
Before I meet you, I already know of you. I am the stranger assigned to prod your wounds and commit your secrets to memory.
“You’re all so nosy. Have you ever thought about becoming detectives?”
Before I meet you, I already know you are dying. In some ways, you know this too. There is no space for euphemisms in the small of your curtain-enclosed emergency department. You are not passing like a truck through an overpass or sand through your daughter’s outstretched fingers. There are no losing battles here.
“I’m tired of ‘you’ll get through this.’ What happens if I don’t?”
I know of you through clinic notes and biochemistry, your cancelled chemotherapy. I read the words “mass” and “malignancy” until they metastasize, permeate through identity. You become your diagnosis. But you remind me you have always been more.
The doctor parts the curtain as she enters. I follow, pull it closed behind me. I am sorry. Let’s pretend fabric is privacy. That there is enough quiet here to hear our own heartbeats. Sometimes, often, this is the best we can do. There is a baby girl screaming in the room next to yours. A man coughing his lungs out through his body. Next to where you sleep, your brow furrowed in pain, your daughter is silently praying.
2. Assessing perception
“What do you understand about the stage of your cancer?”
You laugh. “I don’t know anything anymore.”
What you do know is that a month ago, you were preparing for spring. Pulling the weeds out from the garden, earth embedded under your nails. A month ago, you were dancing at your grandson’s fourth birthday and telling your brother on the other side of the world that you missed him, were thinking about visiting soon. You understand that, a month ago, you felt like you were living — not just enduring — and now … you are here. Bedbound. Drowsy. Blinking through fatigue and hospital fluorescence.
“Forget the cancer,” your daughter says. “Mom’s a fighter.”
You turn your head on the pillow. Close your eyes. We don’t need new blood work to tell you are tired.
3. Invitation
Shall we get to the heart of the issue?
Sometimes, often, the hospital is a place built for simultaneous suffering. There always exists the unimaginable. It eats and eats and eats and forever stays starving. I am not sure why.
How hungry is it today? Would you like to know?
4. Knowledge sharing
I carried your secret on the way here. Folded it, as if it were something fragile, into the pocket of my scrubs. It’s heavier than you would think, more precious. Sometimes, like now, with your daughter holding her face in her hands, it catches in your throat. Reminds you how pain works and how it leaves you less naive. Sometimes, often, it humbles us. Reminds us we are more human than we would like to be.
On the ward, you tell me the coffee is terrible here. Nothing like your espresso machine back home. You used to toast the beans yourself.
You joke, “I’d rather have chemo again than another sip. Honestly.”
For someone who’s dying, you are so full of life.
Is there anything I can do for you today to help you feel more comfortable?
“Oh, no. Not unless … you can cure the cancer? Maybe rewind time? Back to when I didn’t know there was something wrong with me.”
I offer you quiet, instead. Then a tea.
You are trying not to cry in front of me and I can tell. When you close your eyes, I try to be strong, too.
“Maybe something for the pain,” you say finally.
Body aches are easy. Heartache takes longer to dull. How about we try our best together.
5. Exploring emotions
If you want, you can tell me about yours, this quiet grief collecting on your hospital windowsill. At your bedside, I will swallow my own to make more room for you. Tell me about your pain today. Are you still feeling nauseated? Tell me about your family. The way your brother taught you how to fish. Tell me about the bread your husband used to bake every Monday morning. The way you still sleep alone on your side of the bed. Remind me again how to stay soft.
Tender-hearted, despite. Tenderhearted, still.
“Is it terrible of me to say I am tired?”
Holding secrets can be heavy. Let me share this one with you: sometimes, often, medicine can hurt as much as it heals.
6. Strategy and summary
It is not easy watching you become quiet, your fire dimmed. You sleep more. Find yourself confused more often. One day, you reach for my hand. You call me by your daughter’s name.
It is my last day with you.
I never get to see you afterward, but the team says you went the way you wanted. I cry when I find out your brother made it just in time to brush the hair from your brow, the way he used to when you were children.
I think about it often. The way medicine can offer a different kind of hope. Not one for cure, maybe, but one for meaning. For choice. For closure and resolution. A quiet moment to say thank you. I love you. I miss you already. Goodbye.
Sometimes, often, we carry the memories of patients.
In another emergency department, on another rotation, I part the curtain as I enter. Pull it closed behind me.
I remember.
Footnotes
This article has been peer reviewed.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
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