Osmun, W.E.

Day 1

He sits concentrating on paperwork, initialling them off. Pure tedium and interruptions had caused him to miss important information in the past and he forces himself to pay attention. Jill, the clinic nurse, appears at his office door and is silenced by a raised hand. Waiting patiently, Jill looks down like a mother on a spoiled, but favourite, child. Reassured it is nothing important, he looks up.

"Home care called," Jill says, "they want to know if you could make a house call on John Hanover."

He frowns. "Why?" John Hanover appears in his mind; young and healthy.

"Well, he appears to be dying."


"He went into the city two weeks ago with some abdominal pain. They opened him up and he had cancer. He was full of it."

"Nice of them to let us know."

Jill shrugs. "That would be communication. "

"How old is he anyway?"


The doctor whistles. "Shit." He says.

"Shit, indeed." says Jill.

"Any kids?”


"Shit, again." He says.

It is an ordinary house. Reaching behind the seat he struggles to get his hag from between the seats. He gets out of the car and stands studying the blank windows. He goes to the front door past a garden now dead from neglect. The chime of the door bell is depressingly cheery. A haggard Ellen Hanover answers the door.

"Hi," she says, "Come on in. John is up stairs." She motions vaguely with her hand.

Nodding, he slips his shoes off. He climbs the stairs glancing from room to room to find his patient. He smells disease.

"Hey," he has adopted the greeting of his children. He reminds himself to stop using it but knows he won't, Just like he continues to use 'sweet' and 'dude'.

"Hey, yourself, doc." A skeletal hand rises from the bed sheets, floats tentatively then collapses back to the linens. "How are you doing?"

"Good, thanks." He replies. "How about you?"

"Been better." A skull thinly covered with skin smiles, the teeth perfect and white and straight. "Been helluvalot better."

He acknowledges this with a nod. "Any pain?"

John's hands flutter non-committally. "Nah, not really. They got me pretty juiced up. "

"All's he does is sleep." Ellen hovers by the door.

Nodding again, the doctor sits on the edge of the bed. There is really nothing for him to do, so he takes John's pulse. Unfortunately it bounds with life, This suffering is going to be prolonged. "That would be the pain meds." The doctor says, "It is always a little tricky finding a happy medium between pain relief and sedation."

"I'll take the sedation." John says.

Day 7

He scribbles on the note the home care nurse left him, upping the fentanyl as she suggested. Opening his eyes briefly, John acknowledges the doctor with smallest of nods. The doctor sits beside the bed. Ellen sits on the other side, The deathwatch.

"Is there anything I can do?" the doctor asks.

Ellen begins to cry and shakes her head. Looking away, she says, "No, thank you."

"It's difficult." He knows it sounds lame even as the words escape his mouth. John's eyes flutter open again and the slightest smile fleets across his face. He knows it is lame too.

Resting his elbows on his knees, the doctor brings his hands to his lips in an attitude of a prayer. He is not a religious man, but sometimes he wishes he was. There was a time earlier in his career when he would try to make bargains with God, but Gad never came through. 50 he stopped doing that, letting nature take its course without any divine intervention. He taps his lips with his two index fingers.

He places his hand over John's. "I'll be back next week." He says but he doubts it will be necessary. The same smile plays across John's lips.

He hears the kids playing in the back yard as he climbs into his car.

Day 14

Not waiting for Ellen, he enters the house after ringing the bell. He tries to place the tune but he can't. As he passes the kitchen he sees people sitting silently around the table. He nods in their direction and heads up the stairs.

He and Ellen take their seats. "How is he doing?" the doctor asks watching John's face. Nothing.

Ellen is cradling John's hand in her own. "He's a lot weaker." The doctor nods. "He groans sometimes. I don’t know if he is in pain or not. I'm never sure whether to give him more morphine."

Thinking carefully, the doctor tries to find words that mean 'it doesn’t matter' without sounding callous. "You cannot do him any harm by giving him the morphine." He says.

Ellen nods. "Do you think he needs an IV? He has had nothing to drink all day."

"The cancer will take away the need to drink or eat." The doctor replies, "and the morphine helps too. If we start an IV we will only prolong the suffering." He looks at her cautiously, sensitive that she might be offended by his words but he reads nothing on her face.

She strokes her husband's hand. "How much longer?"

Lacing his fingers together, the doctor studies his hands for a moment. He looks up and into Ellen's eyes. "I can’t see this lasting longer than a week but I have been wrong before. Younger people can be very strong."

"I don’t know how much more of this I can take."

Studying her, he says quietly, "Is it important to you that he dies at home?"

"It was important to him."

"I'll call homecare and see if they can step up the hours. Maybe there are volunteers."

"My neighbours have been helping, but they have things to do as well. They have been feeding the kids."

"We'll do our best."

Day 21

John's breaths escape in long sighs, then stop, then start again. "Please die," the doctor thinks then says, "He seems comfortable."

Ellen nods.

John is disappearing into the white of his sheets. Slowly dissolving away. The doctor thinks he is going to die now right in front of him but, of course, he doesn't. His youthful heart beats life through his veins, feeding the cancer that is killing him.

"I almost called the ambulance." Ellen says. The doctor nods. "But he begged me to let him die at home. So I didn’t."

The doctor nods. "It won't be much longer." He says although he questions the prediction.

Day 22

The death certificate lies on his desk. "The funeral home needs it." Jill says, "As soon as possible. They can't bury him without it."

The waiting is over.

Theme: Death and Dying | Décès et le mourir  
Theme: Health Care Delivery | Prestation des soins de santé

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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