They say the only things we can be certain about in life are death and taxes. Always certain but somehow unexpected when it comes.
Every now and again my job has me reflecting on these two, mostly the former.
I find it intriguing how some people are very organised and matter-of-fact about both whilst others find ways to procrastinate or skirt around them until they become inevitable.
One of the most memorable final moments I have witnessed at work wasn't even my patient.
I was in my consulting room staring out of the window one afternoon having a housekeeping moment between patients when I noticed a man standing on the edge of the rooftop of a multistorey car park across the road.
I assumed there was some building work going on and looked closer to see if he had a harness, assuming that there must be some health and safety equipment or barriers to allow him stand so close to the edge.
I looked down to the ground where I noticed a small group of people gathering and looking up at him. Before I could process what I was witnessing, I saw him throw himself down.
A few of us rushed out of the health centre to the scene. An ambulance arrived in record time but it was too late.
For a long while, I kept pondering on the incident. It was shocking and upsetting.
What were his thoughts in those final moments. Confusion? Anger? Frustration? Depression? Was he now at peace?
These days I mostly work from a ground floor office overlooking the playground of a preschool nursery. The sights and sound are more pleasant.
I often try to interprete the look in eyes of the dying.
At a recent home visit to a dying man in his eighties, I saw Fear. He held my hand and cried telling me how scared he was of dying. I asked if he had a faith as I find that people often draw strength from their faith when all else, despite all medical intelligence, has failed.
His wife, who had been interrupting the whole conversation, shouted from the corner. "He doesn't believe in all that. He's an athei..."
""SHUT UP!" He shouted back at her with what little strength he had left. Then turning to me, eyes still filled with tears, hands still shaking, he said. "I am a Christian, I believe in Jesus and the church of England. "
"I hope that you can find some comfort in your faith." I said as I left him and his still bewildered wife shortly after.
In another patient's eyes I saw Courage, which I found particularly chilling as she was just shy of thirty years old, dying from cancer.
"I have to be strong for everyone around me. " She said. "My mum is also in a hospice in her last days. I just don't want to go before her."
In another patient, I saw complete Resignation.
He was a man in his seventies with a lung condition for which he was predicted six to nine months to live, three years before.
I saw him late one Friday evening. His whole family had gathered with lit candles and the priest had come to give him the final rites and communion.
After assessing him, I had to gently break the news to the family that he was not actually dying yet, just badly constipated. I prescribed some laxatives and said I would give him a call the following week. His wife looked at me in horror.
When I did ring him the following Tuesday, his cheerful wife informed me that he was out helping his brother move house.
I was relieved, and for a while shifted my attention from death to taxes.
It was late January my tax bill was due. I looked at it again and turned away in annoyance/denial. I had until 23:59 on the 31st to pay it. It will have to wait until 23:45.
(Photo is the view from the window)
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