General practice is widely considered to be first contact care.Nevertheless for dying patients and their families their general practitioner [GP] or family doctor is often the last medical professional who cares for them. Since people today take much longer to die, this doctor patient relationship could last months or years rather than days or weeks. A few real life examples of such relationships from general practice are given below. The names have been changed for obvious reasons. Hopefully the reader will appreciate the situations in which GPs find themselves, when dealing with these diverseproblems. Suwapath Wewa!
This is usually a blessing that is uttered by the priest of atemple when he meets a dayakaya. Hence when Simon a model of decorum and respect mentioned these words to the nayaka hamuduruwo of the temple when they met, both the high priest and the family realised that something was wrong. In fact this was the beginning of a life ending dementia that had taken hold of Simon. Simon’s family have been long standing patients of mine. After that incident events unfolded quite rapidly for Simon. Three terrible years of mental confusion, injuries, depression, fits, loss of consciousness with enormous hardships for the family followed. On two occasions Simon wandered out of the house and was found in town. I had to support the family with my professional expertise throughout. A specialist had to be consulted once. Simon’s family cared for him with great devotion and love till the end. Dying caring for the dying!
She has been my patient for over thirty years. As the senior mostnurse in a well known free hospice for terminally ill cancer patients, she earned the respect and undying affection of countless patients and their distraught families. Suneetha is also dying. Her illness is a debilitating degenerative disease of the nervous system. This too is a life limiting condition. Suneetha has been suffering for close upon eight years. Getting her up each morning is a major operation for the family. Her legs barely respond to her brain and keeping steady is almost beyond her. The nights are agonising with severe cramps and insomnia. The disease has now affected the nerves controlling the muscles of the chest. Suneetha flies into fits of uncontrollable anger. Her feet are swollen. The family is heroically coping. Suneetha knows she is dying but also living in the hope that caring for terminally ill patients would bring her merit in her samsaric journey. The patient who refused to die!
Sometimes it is difficult to assess whether a patient is in the last stages of life or not. Hilda’s story was one such instance. Hilda was ninety years of age and was afflicted with Chronic Obstructive Airways Disease or COPD. COPD at that age is a life threatening disease of the lungs. Having examined her on that fateful day I concluded that she was finally dying. A professional colleague brought in by me to review Hilda’s impending demise. Her daughter set off to the ancestral home forty miles away to prepare the old place for a fitting send off for her mother. Hilda, God bless her, however kept on insisting between gasps of breath that she was not dying! Fortunately for all of us so did another doctor who happened to be a close relative of Hilda’s. To cut a long story short she lived for another five years! Hilda finally passed away without warning, immediately after she had eaten of a hearty meal fed to her by her daughter.Why in heavens name are children like this born?
This was not a cry of despair from a mother of a child bornwith Cerebral Palsy. It was an unfortunate public comment of a doctor who was attending on Sumana’s son who had cerebral palsy. Sumana related this story with tears in her eyes to me. On numerous occasions she had carried this first born severely disabled child into my consultation room for treatment. He could neither walk nor could he talk. Cerebral palsy is a life ending disease that affects some infants from birth. Brain damage that occurs in the womb for a variety of reasons is the underlying cause. Like many other mothers of such children Sumana’s devotion to her son with cerebral palsy was wonderful to behold. As her family doctor all I could do was to support her during the many episodes of illness that her child went through. Sumana was also the mother of a normal, pretty girl and the wife to a husband who was the sole breadwinner of the family with lots of demands for himself and little concern for his disabled son. A Happy Death?
No one has come back from death, after a reasonable period of time that is, to tell us what they experienced. So it would be even more difficult for us to identify a happy death. But the circumstances of Maggie Nona’s death must surely qualify to those who were alive and around ,that this would be how they too would like to die. Maggie Nona was a patient of mine who was always calm and exuded grace. Her husband predeceased her by about a decade. She was suffering with heart failure another life ending disease. Shortly after she died her children came to me with the news of her death. They were happy! She had been giving alms to the priests from the temple. It had been an almsgiving to bring merit to her late husband. She had collapsed while serving the priest with a smile on her face. Nopain no distress. Surely a blessed and happy death.
Dr. Eugene Corea
General Practitioner – Piliyandala
Past President CGPSL
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