Funny, but I found myself grieving longer than I expected. Although, as a physician, I understood and realized that my patient was going to die, I had a hard time letting go. I thought how her family must feel. I was sure they were thinking the same thoughts-if only I could have convinced her to stop the salt, take her medication for high blood pressure (hypertension) and sugar (diabetes). We understood after her stroke that it would be difficult.
When asked who I was, sometimes she would say " Dr. Chrisaaan". Other times, she would just stare blankly at me. She would always fuss and cry in pain when I moved her hand. I would talk to her. I would tell her since she is not moving it, I have to move it. I would try to get her to understand why we were hurting her. I would try to get her to understand that if you do not use a part of the body, you lose that part-you lose the function of that part. At times, she would smile as if in recognition.
I thought I had been there for her. I had told her repeatedly how to prevent a stroke. I had told her that if she had sudden weakness or numbness of the face, arm, or leg on one side of the body to get help immediately-call 911. I had told her that if she lost her speech or had trouble talking (something she did all the time)-to call 911. I told her if she had a sudden loss of vision, especially in one eye to call for help-call 911. I told her if she had unexplained dizziness, unsteadiness or a sudden fall-to call 911. She would laugh. She would say " I old already". "I ready when the time comes." I would counter that she already fussed about being a burden on her family. A stroke would really change the meaning of burden to big, big burden. She would laugh. I would tell her please follow her diet, take her medicine, exercise. She would say, "I don't eat much doc. I take my medicine. It too dangerous and I too old to go exercise. My legs hurt and I can barely walk." I would counter with all the logic and arguments I learned throughout my medical career. In the end, I knew she was in charge.
Her family was always there for her. They talked to her; bathed her; healed her bedsores that she had gotten while in the hospital. They moved her from bed to wheelchair, from inside to the sunny outside.
She had lived alone since her children were grown. Her daughter had always asked her to live with her daughter and daughter's husband. But she refused. She would always tell her daughter that her daughter had enough on her hands with a husband in a wheelchair from an amputation caused by not taking care of his diabetes.
But she would also say her daughter had no time for her — too busy cleaning and working and taking care of others. I searched for a way to let her know as a doctor that somethings do not come easily. I tried to tell her that she should enjoy the times she had with her daughter. I tried to tell her that her daughter wanted to do much for her but could only do so if she compromised. I could sit and look her in the eye, see her anger, let her get as angry as she wanted to with me. I would think-just please don't hit me with that cane. I would hear her laugh at my politeness; I could feel her strength.
After her stroke, her daughter was there everyday. Her sons were there every day. I could feel their pain of not knowing what to do to please her — to make her well again. Why do we have to learn when it is too late. I could hear her thoughts-why do they keep sticking me with needles and turning me from side to side. Don't they see that I am sick and need to lie still. Although each day we saw her deteriorate more and more with her toes and fingers turning black, we could see the care she was receiving from the nurses. The family would joke to see who would first each other to bath her-the nurse or the daughter.
Then she started vomiting blood. I knew the end was near. I spoke with the daughter. The daughter was in pain. What if she dies and I am not there. I tried to tell the daughter, you were there for her in life. Death is just another part of the cycle of life. You are doing all you can for her. But the daughter was in pain. All of those prior conversations when her mother told her daughter that the daughter is never around when she needs her were subconsciously there. But the daughter was doing all she could. The daughter had devoted all of her time to the mother. The daughter was exhausted.
She died last night. The daughter was not there. I found myself missing her grit. I realized looking back, that I had to accept her on her own terms. I realized that I had to see her enthusiasm for opposition and confrontation. I could see that she had given me a great gift as a patient — her laughter, her trust and even her tears. What greater gifts could a patient offer her doctor? I wanted obedience, compliance, and long life from her.
I prayed in silence that she was happy.
Editors' note: Dr. Cora Christian is a board certified practicing family physician. Christian is credited with the development of the Frederiksted Health Center, both its renovation from the old hospital into a functioning health center — only one of her many achievements in public health. After many years in public service she is now medical director of Hess Oil Virgin Islands Corporation, now HOVENSA
