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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 30; 334(7608): 1376.
PMCID: PMC1906618
The Bigger Picture


Mary E Black, public health physician, Belgrade, Serbia

My auntie, Kate Fitzgerald, lives in Cork and I live in Belgrade. I have to juggle flights, family, and pressing work deadlines to reach her nursing home in a small village so as to have a clear two hours to spare for the visit.

Auntie Kate—the fearless Irish nun and missionary surgeon who ran district hospitals in Nigeria and Malawi. Deceptively small and pious, she had seemed the epitome of glamour and feistiness and had inspired my dream of working as a doctor in Africa—a dream I nurtured for years through medical school and junior doctor jobs in child health, obstetrics, and tropical medicine. A dream watched over by a little wooden elephant that I still keep on my dresser. Circumstances and choice had led me to another reality and another busy and interesting life.

I rush in the door to be stopped in my tracks; the matron tells me that Auntie Kate now usually sleeps until midday and has only just got up. Slowly, slowly they arrange her morning finery.

Our time clocks meet. Mine threatens to race past her until I put on the brakes; hers speeds up as she has a visitor. An aide wheels her to a sitting room, and another age passes while we organise her hearing aids. There she sits, 84, blind and almost completely deaf, frail as a waif.

She recognises my voice, and to see such a warm smile on a blind old lady's face is as good as watching your small child smile in its sleep. We hold hands and she feels my face a little and then we talk.

Phrases and stories bubble to the surface half formed. The children and mothers, the hospitals and the other sisters, the politicians on first name terms, the making-do on a tiny budget, heroic operations in a power failure, rains and drought, celebrations. The bubbles pop and evaporate and tail off in a whispered word. I am the only one of her visitors now who asks about Africa, and I ask her only once a year or so. But she still remembers it all.

The tea arrives, and I help her with her large blue plastic mug; the only sound in the room is of her slow sipping. My important schedules fall into irrelevance, just as all hers are long gone. Then the train and the flight from Dublin and my children waiting back home intervene.

I pause to look back through the glass door. I see her veined, delicate hands, quietly at rest now in her lap. I imagine them busy in surgical gloves, and the thousands upon thousands of sutures they have placed. I see the life she has led and I have not.

And as I gaze at those hands, once again I see Africa.

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