The Yellow Canary

Rappaport, Maureen

One of the things we cherish most in the practice of family medicine is the doctor-patient relationship but unlike the other things we do, this is something hard to measure. We cannot palpate,auscultate, biopsy, or count it; but not everything that can be counted counts. Good communication, mutual trust and respect are like clean air. It would be nice if doctors had canaries to warn us of impending toxic miscommunications, or sing sweetly when we get it right.

Emmie Sebald had been healthy in the fifteen years I had known her. As they age most people assume their unique personalities and Emmie was no exception. She was a childless widow who loved to talk, so her yearly checkups were more social than medical. I enjoyed these visits as much as she did, but it was inevitable that one day disease would come between us.

At the age of eighty-six Emmie Sebald developed a pain in her belly which didn't respond to her usual cure of boiled dandelion stems. She waited six months before coming to me. Putting a hand on her abdomen told me everything and she probably knew it, but we waited for the ultrasound and cat scan to confirm the ovarian cancer with mesothelial spread.

"Why don't they just leave us old folks alone?" she asked when I gave her the bad news. I wasn't sure if she was referring to the gods for handing out illness or the doctors (myself included) for arranging nasty tests and proposing even nastier treatments.

Those yearly visits paid off when I finally convinced her to have a biopsy, see a gynecologist and go for chemotherapy. After three months a thinner (90 pound), bald but still feisty Emmie was arguing with me in my office.

"I can't possibly go for the surgery,"

I was about to re-assure her about bla, bla, bla, when she held up, her thin, right arm, and pointed a crooked index finger at me. "After all, who will look after Joey while I'm in the hospital?"

I learnt that day that my patient had a yellow canary and not knowing what else to do, I offered to take care of her bird during her hospitalization.

My kids liked Joey, though he was old and scraggly like his mistress. Tammy, my eight year old, thought he may have been too sad over the little-old lady to sing. He also pulled out half of his feathers.

I brought Tammy and Michael, my ten year old, with me to Mrs. Sebald's apartment, when she was strong enough to take the bird back.

"She's really old," whispered Tammy from behind my thighs as she peeked at the bird lady.

Emmie Sebald had one good year but then her cancer returned. She decided against any more active treatments. We were lucky to have access to a wonderful team of palliative homecare professionals that allowed Emmie to stay home almost till the end, and for me to have the support and collaboration I needed as a doctor doing palliative homecare.

I remember those house calls. I would ring the apartment buzzer and make my way up the three flights of spotted stone stairs. Emmie kept the chain on the wooden door as she wedged the side of her face in the crack to see who was there.

"Oh, it's you. Come in Doctor, you pass me, I'm slow," she commanded.

I don't know how she managed on her own. Her legs were swollen, her belly bulged, and she still weighed only 75 pounds. The old canary was looking very well. His feathers were abundant and bright yellow. He was tweeting sweetly.

"Joey is happy you came."

We talked about my children, about the value of fresh calf's liver, about her nosey neighbours. She never wanted to discuss the stuff they taught me to discuss; advance directives, last wishes, fears,
One day Emmie Sebald was found lying on the floor. She had been there for over twelve hours. She could no longer manage on her own.

One morning I visited her on the palliative care ward. She was curled up, like a little bird, on a bed on Five Main, dying.

"Who's going to take care of Joey?" I asked, when I really wanted to ask if she knew she was dying.

While still at home, Emmie spoke as if her swollen legs and belly would get better.

"I guess it's time for him to die," she said calmly.

I couldn't stop the tears from falling as I told her I intended to write a story about her and her bird.

She smiled- a real smile. Church bells began chiming (we were in St. Mary's Hospital), as she continued to smile. She didn't blink, her pupils looked dilated. I thought she was on her way to heaven and despite all my experience with death, I was afraid. But as I looked down at her bony chest, I saw it rise and fall, her breath trembling.

Or was it me trembling?

Theme: Patients | Patients
Theme: Physicians | Médecins
Theme: Relationships | Relations
Theme: Death and Dying | Décès et le mourir 

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




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