Farewell to an old patient
The police phoned me at home one weekend. Could I complete a medical certificate of cause of death? My patient, Ian, had been found by a neighbour, dead on his lawn beside a motor-mower that was still running.
I could make a pretty good guess as to the most likely medical event. Although Ian was only 60, his risk factors for coronary heart disease lined up against him like witnesses for the prosecution. We had discussed the chances of a life cut short on several occasions.
Yet a jolt of sadness and loss went through me when the officer named the person who had died. Ian was a jovial and entertaining character, and we had known each other for many years. My efforts to prise him away from a self-destructive lifestyle, came from a genuine concern for this likeable patient.
Ian was for cremation. He had lived with his parents until they each died, and then alone in the family home. He never mentioned having a special or an intimate relationship. His social life revolved around hanging out with his male friends on the golf course and at the club.
Farewell to an old patient
Oh, Ian, so suddenly you’re gone.
These cold purple lips
delivered denial
through our twenty-five years together
kissed the smokes
sank deep the 19th hole with your mates
cheerily asked for the bad news
at every visit, while I kept saying
what doctors are expected to say
repeated quarterly
along with ritual weigh-ins
lab tests and prescriptions
and all that diabetic crap.
Bald, bearded, round
this face under the sheet.
Your iron defence, always jovial
eventually rusted
to an anxious edge
as you borrowed time nearing sixty.
Sure, Ian, you accepted late
the need for needles
and made your peace with pills
but the habits of a single bloke
life-blood and death-trap
were never really on
the negotiating table
were they?
As I drove to the premises of the funeral director to view the body, there was time to reflect on whether I had served him well as his GP. My efforts were based on repeated gentle nudges on the wheel of behaviour change. Gentle nudges, politely blocked. As with many of our patients, Ian found accepting the need for daily medication, even when that escalated to include insulin injections, easier than giving up the cherished habits central to his social life. What he lived for, eventually killed him.
… the habits of a single bloke
life-blood and death-trap…
So, I asked myself, how much does an abrupt death at age 60 in a man with no family, no dependents, represent failure? Are we overly concerned with how long one lives, rather than how well life is lived?
Suppose I had persuaded Ian that his only hope lay in removing himself from his circle of friends and the habits they shared, and he had complied, living perhaps to the age of 65 but in social isolation. Is that what medical success looks like?