The House closest to Heaven

September 12, 2011

The skinny man reaches over his jug of water and points to the picture on the wall. “That’s my kids”, said he. We saw two kids, aged 7 and 9, standing around a birthday cake as he smiles at the camera. This was not too long ago; he was well built with a robust complexion.

“They are very cute”.

He smiled. Now a shadow of his former self. This is the same person as the one in the picture, yet now they are worlds apart. Fatigued and jaundiced as he lay frail on the bed. The cancer had already spread to his liver.

“I really want to go home. I know I only have a few months. There is nothing I want to do more than to go home to spend time with my kids”, he spoke in almost a whisper.

A soft sniffling can be heard coming from behind. I stood still, not wishing to turn around. Part of me not daring to ‘acknowledge’ the sorrow in the room – as his elderly mother shed tears over the harsh reality of his prognosis.

“We’ll get you as strong as we can quickly so you can go home soon”, reassured my consultant,  “If things take a turn for the worse, you can come back to us for end of life care here”.

He nodded slowly and deeply, turning his gaze to the field beyond the window. As we headed out, I caught a glance of his parents behind me. The mother was wiping her eyes silently while his father wore a solemn expression over his aged face.

There is this inexplicable sinking feeling in me knowing that the next time I see him again, it won’t be for very much longer.

*     *     *

The young lady with long black hair looked up from her seat. A deep frown embedded over her forehead. Her eyes looked almost pleading.

“How long does he have left?” she asked, in heavy accented English.

I looked at my consultant whom shook her head. “We don’t really know for sure, but it might just be only a matter of days”.

The man is barely conscious. Every now and then he would mutter something in his sleep, and then heaviness would wash over him. We were told that he has been requesting for his son ever since he started deteriorating.

“My brother is still having issues with his visa. Hopefully it should be approved by today and he could fly out here to see our father…”, she trailed off, before hesitantly adding “…I hope he’ll be here in time”.

Soft chanting of monks filled the room. A small black player on loop can be seen placed by his pillow, no doubt containing incantations of religious scriptures. The atmosphere was heavy yet serene.

Wonder if the son will be here soon?

*     *     *

“Do you have any pain?”, we asked. Her eyes were half closed, eyelids occasionally fluttering. Was there a faintest hint of a nod?

We could hear her murmuring incomprehensibly between her laboured breaths. Her sister reached out and held her swollen arm; limbs severely edematous from the steroids. Pale, bed-bound, and completely devoid of hair, she looked much worse that day compared to a week ago.

I looked at the syringe driver which was humming by the bed. Continuous infusion of potent analgesics and sedatives were pumped through the subcutaneous butterfly cannula in her arm. Her pain had been unbearable, described as a burning sensation spreading across her chest. The cancer had spread beyond then.

Her family were gathered in the room. One of her daughters approached me with tears welling up in her eyes. “Is she able to hear us?”.

I looked at their mother in her semi-comatose state. Suddenly I became conscious of my own breathing given the stillness in the room as they were all waiting on me to speak.

“She has been in this unrousable state for some time, it is hard to recognise when she is truly asleep and when she is just merely closing her eyes at rest. We do not know when she is drifting in and out. I encourage all of you to keep talking to her as you do; I am certain there are times when she is listening, we are just not sure when. Keep talking, you never know.”, as I nodded to the family in assurance. They gave their thanks and I left the room.

Is she able to hear us? I don’t have the answer. But I know the answer that we needed.

*     *     *

           The stories are reflections of a regular day in palliative care. It is moments like these when you deal with the very real face of mortality. Thoughts and insights often dwell on the vulnerability of the living being where disease and death spares no one. To the afflicted ones, time is extremely precious when there is little of it left.

The following are excerpts from a poem by William Knox :-

Mortality

Oh, why should the spirit of mortal be proud?
Like a swift-fleeting meteor, a fast-flying cloud,
A flash of the lightning, a break of the wave,
He passes from life to his rest in the grave.

The leaves of the oak and the willow shall fade,
Be scattered around, and together be laid;
And the young and the old, the low and the high,
Shall molder to dust, and together shall lie.

The hand of the king that the sceptre hath borne,
The brow of the priest that the mitre hath worn,
The eye of the sage, and the heart of the brave,
Are hidden and lost in the depths of the grave.

The peasant, whose lot was to sow and to reap,
The herdsman, who climbed with his goats up the steep,
The beggar, who wandered in search of his bread,
Have faded away like the grass that we tread.

The saint, who enjoyed the communion of Heaven,
The sinner, who dared to remain unforgiven,
The wise and the foolish, the guilty and just,
Have quietly mingled their bones in the dust.

For we are the same that our fathers have been;
We see the same sights that our fathers have seen;
We drink the same stream, we feel the same sun,
And run the same course that our fathers have run.

Yea, hope and despondency, pleasure and pain,
Are mingled together in sunshine and rain;
And the smile and the tear, the song and the dirge,
Still follow each other, like surge upon surge.

’Tis the wink of an eye—’tis the draught of a breath—
From the blossom of health to the paleness of death,
From the gilded saloon to the bier and the shroud
Oh, why should the spirit of mortal be proud?

– From The Lonely Hearth, The Songs of Israel, Harp of Sion, and Other Poems –

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