Can't you give her a needle?

I had met her at the main hospital. She had metastatic colorectal cancer. She had received extensive chemotherapy. Her disease had progressed and her options were rapidly diminishing. She was becoming thinner. I talked to her about palliative care and what the hospice had to offer. She agreed to come over to the hospice. Later that week I saw her there. She was in a single room. She lay weakly. The bed covers seemed too big for her. Her mouth was dry. She spoke slowly. After discussing her symptoms I said to her that I thought her time was approaching. She said, "Well, what can I say?" I asked her what was the hardest aspect of her illness. She replied, "Leaving my husband". I met Jack twice over the next days. On each occasion he sat by her bed speaking as softly as she, his eyes burning with suffering. By the week's end she had deteriorated further. She was now unrousable and dying. I entered the room. Jack sat, as usual, by her bed his right hand resting on hers. Next to him was their son. I explained the process of dying and said that I did not think it would be long. There was a pause. Finally Jack looked up at me and asked, "Doctor, can't you give her a needle?" I had heard the question before from relatives of other patients, at other deathbeds. I knew how the sentence would end. I was ready with an answer. I knew that the sentence would end with "a needle to end her suffering" or "a needle to put her out of her misery". My answer, prepared and clear would be No; that ethically and legally we cannot cause anyone to die or hasten their death and that the natural process of dying, already progressing, would inevitably lead to her death. But the sentence did not end that way. The sentence ended in a way that was so different, unexpected and on a plane that was so separate from what I anticipated. He completed the sentence by saying, "Doctor, can't you give her a needle to wake her so that we can speak one last time?" I stood there, silently I reached out my hand to his hand that lay on hers. Three hands. I felt many things, humbled that my expectations, the grooved furrow of the plough across the field of my working day was not prepared for this question. That the question itself arose deep from his anguish of loss. That a lay person could honestly believe that we could do such a thing, wake a dying patient to speak for one last time. Have we so raised the image of modern medicine that doctors are seen to be capable of the miraculous? And I began to think of language -- the language of our patients and their loved ones and occasionally a comment or question can be both practical and metaphorical, literal, and figurative. And how language can rarely capture the exquisite mystery present in the process of dying. Or is it so rare? Maybe we need to be more open to the asides, the whispered thought, the silence that so regularly envelops it all. And finally it reminded me that talk of death is not nor should ever be clichéd, that every encounter, just like every death, is unique and that our confident anticipation of the content of all encounters rests on a flawed premise. The premise of sameness. We will be surprised and humbled, moved and challenged. And rightly so. "No," I replied, "sadly there is no such needle. I cannot wake her now. But Jack, talk to her, she'll know you're here, talk to her of everything, everything that's in your heart". Quietly, and in a whisper to match her breathing, he replied, "I have been speaking of nothing else". Frank Brennan is a palliative care physician based in Sydney.


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