Letting go…

A melanocytic nevus.

I have never had to use the doctor’s room in my ward. Mostly because I never get time to sit down. I am constantly on my toes reviewing a patient or following up with surgery to review their patients who were erroneously admitted to our ward. Ward 3, Female Medical. It’s always tricky dealing with surgery, you all know. They are never commital.

I got into the doctor’s room. Jane, not her real name, was already seated. I had asked her to go in before me as I was finishing a bedside chest tube insertion. She was plump. The kind of plump that is motherly. The kind that you don’t body shame. Probably this was from the many children she had born and bred. She looked exactly like my mother except that she was brown with a conspicuous black dot that stood on her left cheek like a square peg on a round hole. If you zoomed closely, probably you would see some hair coming off the black thing. It’s called a melanocytic nevus. I love the grandeur of Latin. I later learned from our talk that she is an accountant; she didn’t tell me where, but probably with KPMG or Deloitte or one of those monster companies that rake in billions as annual profits.

The atmosphere is tense. Tense and grim. Jane tells me that Juliet is her sister. Juliet is not her real name. Sister from the same womb and balls. The sister you are born and grow with. The one you play hide and seek with. Jane is the big sister. Their mother went to be with the Lord when they were young. The father died of cancer soon after. “Cancer of the throat,” she said. Since then, she has assumed the role of a mother and a father to her little siblings. Being a hard-working woman, she was able to put them through school. She struggled a little, but her siblings went all the way through to the university. She talked like a proud parent, except her eyes were heavy with tears.

“Daktari, I have spent 5 million on my sister’s treatment. She has had countless surgeries. I am tired. I don’t know what else I can do.” Really, there was nothing else she could do or could have done differently. Her sister had been admitted to our unit with an infection. An infection only because the white cells were elevated. Sometimes an elevated white cell count doesn’t mean anything, really. She had lung cancer. Stage IV. With spread to the brain. Now she was mute. The only thing that bore semblance to living was how she closed her eyes when flies landed on them, a primitive brainstem reflex. She was only thirty-seven. Her body was failing her. She had bought a home, and a nice small car like all serious thirty-seven-year-olds do as they anticipate the beginning of life at forty. In her wisdom or lack of, nature was misordering her death. Why not the ninety-two-year-old with stroke in ward 4? In life, you never ask why not. Life has no Fairplay. It beats you when you are at the heart of the game. She had coughed up blood until she could cough no more. The cancer cells had probably depressed the brain’s cough centers. Mortality was imminent. I wonder what people see when they are about to die. Folks, Is it white light that people see? Is it blinding or calming?

A wall separated us from the agony of Juliet.

“You have done your best; there is nothing more you can do. We can’t do much either,” I say to Jane, feeling a little embarrassed. Is that not what we all do to our loved ones? We treat them all the way to death. As a doctor, we must always do something. In her sister’s case, I would probably put her on a short course of antibiotics and call the cancer team to come ‘poison’ her with chemo or radio. I resisted the temptation. It was time for a drug holiday.

The silence that ensued between us was uncomfortably dense. Jane’s tears rolled down her cheeks and then over the black thing to the table that was between us. I got a chance to scan the room again as a means to escape her gaze. The room was disorganized. Unused tubes, catheters, and drugs littered the floor. I sat on a creaky chair close to the door. She occupied the bench on the opposite side. One side of the bench was supported by a carton holding fluids. It was a clear depiction of the appalling state of our public health system. This was the place I was meant to be holding family conferences. I thank God I never had to do it there.

“What do I do, Doc? ” she now burst into a loud cry. She was talking to me like a friend. I realized that because of how she turned her head in a way that people don’t do in a doctor’s office. I felt so sorry for her in those moments. ” Perhaps, you should let go,” I said. I thought she would jerk and stop crying and look at me suddenly. She did not. I don’t know whether I was brutal, but I tried to the best of my ability to let her know the truth. Life was on its way out; it was just a matter of time. Hope is bad. It fuels rage.

I don’t know how long we sat in there, but we agreed that Juliet would not undergo any chemo or radio when we came out. That she would go home with her and watch her die in their home, in a warm blanket, with the aroma of roasted coffee and caring hearts. Jane said that together with her family, they would sing her Christmas carols in the dead of night and early in the morning. She took comfort knowing that even if her sister was not talking, she could see. Do you ever wonder how it is to live in silence? Maybe we should be grateful for the functional state we enjoy. Maybe life is one big pyramid scheme, and you never know when it will crumble.

This holiday season should remind us of how and when to let go. Letting go opens many possibilities; it gives us a chance to die at home with dignity, away from tubes, catheters, fluids, and an overworked medical intern. It also reminds us that the cure of a disease does not have to be more grievous than its endurance. Merry Christmas!