Being Present [translation]

Marchand, Patricia

Winner, AMS–Mimi Divinsky Award for History and Narrative in Family Medicine for a story from a family medicine resident or medical student.

It’s a fact: the discipline of medicine is changing before our very eyes. All too often, however, science and research, not human beings, are given the credit. Medicine has been shaped as much by physicians as by patients. Over time, our knowledge has expanded and evolved, and so have we. Now, instead of saying “I know,” we say “I understand,” even though we can only understand an infinitesimal part of the other person. One of the gifts of practising medicine is the pleasure of discovering a multitude of realities. We are given a window onto the world; we open it and experience new things that enrich our own lives beyond measure.

My story begins on a spring day. I was seeing Mr and Mrs Camino at the “home,” the palliative care centre where I work. Mrs Camino was terminally ill with cancer. She and her husband struck me right away as a couple who were very close—close in sickness and in health and now, soon, in death. Mr Camino told me that when they met, they were 16 or 17 years of age. That was over 50 years ago. Together, they had traveled the world and now her cancer was tearing them apart. His eyes shone with both sadness and joy as he shared these wonderful memories, talking about leaving his country during the war and going to live in Argentina, where he met her. Later, they emigrated to Quebec, got married, had two children and several grandchildren. His Spanish accent added a touch of warmth and colour to his anecdotes. I have always found Spanish to be a vibrant, passionate language. When he searched for a word, he would turn to his wife, and they would speak in Spanish for a few moments. He was clearly devoted to her and had done his best to care for her and make her comfortable. However, I could see that he no longer knew how to cope, what to say, or what to do.

Mrs Camino’s cancer made it difficult for her to breathe. She spoke very little, but tried to communicate as best she could with the staff. When she was first admitted to the home, she could talk, eat, and get out of her chair from time to time. Our brief discussions had been precious. In the past few days, her breathing had become more laboured; her morphine and oxygen doses were increased. She had fewer and fewer waking moments. When she did wake up, she was often confused and became agitated and anxious. That morning, she seemed to be in discomfort.

A prisoner

When I entered the room, Mrs Camino was awake and calm and looking at her husband. She recognized me and smiled, saying my name. Her breathing was shallow and her answers to my questions were clipped. “Are you in pain?” “Yes! I am suffering!” “Where does it hurt?” “I am suffering because I am ready to die and death is not coming.” Now that everything that needed to be said had been said and everything that needed to be done had been done, she felt that it was not fair that she should have to wait. She was a prisoner in a body that refused to let her go. From the other side of her bed, her husband sobbed. I could not put my thoughts into words. I said nothing.

Mrs Camino told me that she wanted to speak to her husband. I offered to leave them alone; however, she insisted that I stay. Her husband came and stood beside me. She took my hand and then gazed into her husband’s eyes, saying, “I love you. I have always loved you.” He bent over her and took her in his arms. She continued to hold my hand, and embraced her husband with her free arm. They wept silently and murmured to each other in Spanish. With my scant knowledge of Spanish I was able to understand that he loved her deeply and soon would be joining her in heaven. Unable to contain myself any longer, I cried silent tears. When she let go of my hand, I wiped the tears from my eyes and slipped out of the room. I sought out a quiet corner; I could suppress my sadness and sense of powerlessness no longer. I cried for their suffering, for their deep love for each other. Some 15 minutes later, I was able to calm myself. When I left that quiet corner I had stopped crying but my eyes kept filling with tears of despair.

A witness

I was overwhelmed by my emotions. I felt powerless to help her and yet I knew that something was being asked of me. I knew that I needed to go back to the room, even if it was just to explain why I had left so abruptly. I needed to end our visit, but what could I say? In my mind, I kept asking myself, “What am I going to say to them?” I was the privileged witness of a love so intense that I wanted to shout out, “This is not fair!” It was not fair that she was sick and now that she had faced her own death and was ready for it, she had

to wait. It wasn’t fair! I was the physician; I felt that I should be able to do something. Had I not spent years in school learning how to heal? I felt powerless. At the same time, I felt so privileged to witness their love for each other. They had drawn me into their love as if to say, “We have not loved each other in vain. You are our witness.”

As I returned to her room, the words came to me. I would tell them that I had heard them. “I wanted to give you a few moments alone. You have given me a wonderful gift by sharing this moment with me. As for your request, I do not feel that I have the right to hasten your death. However, I will do everything in my power to make you comfortable and to ensure that you have as many moments of happiness as possible.” Then I sensed that I needed to comfort her husband. “And your husband is taking such good care of you!” I said. She nodded and when she looked at him, his expression of worry disappeared. I did not want him to wonder; I wanted him to know that what he was doing was appreciated—that it was enough. Mrs Camino died the next day.

And so it was that this couple, who had stirred up so much emotion in me, taught me how to be a better caregiver and a better person. They had helped me to grow.

We try to give meaning to our lives every day. When confronted with our own death, however, we want it to have meaning for others as well. Otherwise, we have lived in vain. Human beings are defined by their ability to change their environment and that includes the people around them. Medicine cannot be defined in terms of techniques alone; medicine includes the process of being present for our patients who are dying. We must not be afraid of being present for them; they can teach us more about life than any book can.

Theme: Death and Dying | Décès et le mourir
Theme: Patients | Patients

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




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