Mrs. Smith^* is dying.  This is the first thing that I find out about her.  The second thing I find out is that it’s not an easy thing to say g’day to someone when you know that they’re dying.  What’s next?  What do you say after you’ve said g’day?  Nice weather?  She knows that she’s dying and so do I.  Some of her family are present in the room and they all know that she’s dying too.  Her children and some of her young grandchildren.  Her husband who loves her so much that you can see it without looking at him directly. 

“How long might I live?” she asks unselfconsciously… “November?”.  “Maybe” is the prognosis. 

That’s not long when it might be all you have left.  Where will I be in November?  I see her daughter crying, even though she doesn’t want to.  Mrs. Smith tells me later that this daughter is the strong one who will keep things together in the hard times to come.

The next thing that I find out about Mrs. Smith is that I have a lot of respect for her.  She is very strong.  She is a woman who knows her worth.  She’s worked in health since she was old enough to (before, actually).  She reminds me of my mother.  They are the same age.  She reminds me of everyone’s mother.  I can tell already that she is thinking of my interests.  She is seeing the good in me.  Mrs. Smith is that kind of person.

It is suggested that it might be a good idea to come back and talk to Mrs. Smith about the treatment of her cancer.  There have been many people involved.  This is a good example of allied health at work.  I can see that it is and I’d like to talk to her about it, but I would also like to hear about the good times… and there is time for both.  Mrs. Smith won’t be going home for a few days yet.

I chat to Mrs. Smith (and Mr. Smith who is always near) several times.  She’s in hospital because of complications related to her cancer and of the surgery to remove it.  Sometimes visitors will arrive and I’ll leave her to enjoy the company.  Sometimes we are interrupted by a nurse or a physiotherapist.  Even though I enjoy talking with Mrs. Smith, I don’t mind the interruptions because they mean I don’t have to say the definitive “goodbye”.  I just say that I’ll come back another day. 

One of the days I visit her is the first day of her chemotherapy.  It’s disconcerting.  Mrs. Smith doesn’t look particularly ill, her eyes are bright and clear, but we all know what ‘C-H-E-M-O-T-H-E-R-A-P-Y’ means.  We chat normally.  Mrs. Smith isn’t looking for sympathy.  Mr. and Mrs. Smith mention that they love Tasmania and think it would be a great place to retire, momentarily forgetting that Mrs. Smith is dying.  The moment sits heavily.  A month ago none of this was anywhere in their future.

I ask Mrs. Smith if she wouldn’t mind talking about how she found out she was sick and what happened next.  "Of course, if it will help." 

As she begins her story, it is clear that Mrs. Smith is framing the past.  That was then and this is now.  It seems that when you’re dying, it’s hard to forget.  She had been a caregiver, now she is a patient.  Her old colleagues are now looking after her or visiting her at her bedside.  They don’t recognise her in the corridors, and when they do the conversations aren’t like they were before.  She misses her patients.  Life had been great. Time together.  Time with the grandkids.  They had been working outside, looking forward to Mr. Smith retiring soon.  Making plans. 

Mrs. Smith noticed some abnormal bleeding.  That was her first and only symptom up to that point.  Then there was some pain.  She had it checked out by her local physician straight away and was referred for further tests and further examination by a specialist. 

She knew in herself that something was not right.  She waited for the tests to confirm her suspicions.  Her caregivers were excellent.  She was sent to a hospital in Sydney for surgery.  She praises the surgeon.  He did an excellent job.  She shows me her scar and it does look very neat.  She recovered well. 

The prognosis was good, but shortly after it became clear that something was not right.  Mrs. Smith was short of breath and feeling nauseous.  A doctor visited her at home.  It appeared that Mrs. Smith now had pneumonia as well.  Several types of antibiotics were ineffective.  Mrs. Smith knew the implications.  In hospital the next day tests confirmed that Mrs. Smith had cancers in the lung too.  Biopsies were not required.  Surgery was not an option.  Radiation therapy was not an option.  Chemotherapy would hold it at bay, but Mrs. Smith’s cancer would be terminal.

There’s bad news, and then there’s very bad news… and then there’s the sort of news you never want to have to hear.  She appreciated the honesty and also the respect she has been treated with.  There was a psychologist who visited her in hospital.  She was grateful for that as it helped her to order her thoughts in a way that she couldn’t when talking to a loved-one. 

Mrs. Smith is a high-risk for developing thrombi while in bed.  She doesn’t tolerate exertion, so walking is a limited option.  In addition to medication prescribed by her treating doctor, a physiotherapist at the hospital developed a regime of bed exercises to help move the blood out of her legs and through her system.  It appears that the cancer might be in her bones too.  “What next?” she jokes.

Mrs. Smith just wants to go home.  I don’t blame her.  This is too much bad news.  Better the comforts of home and family.  An occupational therapist will need to assess The Smith’s home first.  If Mr. Smith is to care for her at home, there must be precautions to ensure her safety.

It is a very sad thing to see this happening to Mrs. Smith, and a very difficult thing to reconcile.  I don’t try and find reason in the situation because I know it is an absurd thing to look for.  Reason?  There is no logic to put order to Mrs. Smith’s situation.  I do understand something I heard earlier this year though, about the rewards of palliative care.  About the nobility of it. 

Mrs. Smith does not deserve her suffering.  Neither does Mr. Smith or the rest of their family, but the gratitude they express for the personal treatment and concern of their caregivers shows that even when there is no cure, there is a lot that can be done.  As sad as it is to think about, being a small part of the final chapter in someone’s life, especially someone like Mrs. Smith, has helped me to understand the privilege of it.  The last thing I say to Mrs. Smith isn’t goodbye.  It is thank you.