Search tips
Search criteria 


Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2009 October 1; 59(567): 788–789.
PMCID: PMC2751930

The finish line

My apologies to chance for calling it necessity.

My apologies to necessity, if I'm mistaken, after all.

Please don't be angry, happiness, That I take you as my due.

May my dead be patient with the way my memories fade

My apologies to time, For all the world I overlook each second. (Wislawa Szymborska, Under One Small Star).

This ward is set up in such a way as to have eight patients in each section, immediately in front of the nurse's station, behind which I am standing. I prepare the blood results before the consultant comes and asks me whether I have any answers to his questions, and if not why not, since they are the same questions that he asked me yesterday.

I have my share of the work, and my colleague (another SHO) has her's. I am pleased that there has been a just division of labour, and in any case her presence is always reassuring since she is more experienced than I, and so can help me out of the occasional awkward moment.

He arrives, and I observe he is in a good mood, and the ward round begins.

I, the most junior, push the notes trolley around, and thankfully she does most of the talking. She is preparing for MRCP, and so he asks her all sorts of questions to which she gives all sorts of answers. I, on the other hand, remain silent, and scribble down the various jobs that he has asked of us: ‘Chase Mrs B's bloods’, ‘Mr X needs CXR’, and so on.

We finally get to Mr L, whose bloods are also back, and the SHO forewarns the consultant. We were partially expecting this. He had some weird haematological thing, and the consultant haematologist had spoken with my colleague earlier and confirmed that it was the bad news they were expecting. Prognosis: ‘about 9 months’.

‘Your blood results are back’ … ‘and I'm afraid it's not good news’. My mind flashes back to med school, and sessions on ‘how to break bad news’. The consultant is doing well. The inevitable follows:

‘How long, Doc?’

‘About 9 months’.

We wait for a minute or two in an uncomfortable silence made only slightly more comfortable by the experience of the consultant who's obviously been in these uncomfortable silences before. And in this moment I see in Mr L's eyes a look. He knows he is dying. He has been on this earth for 58 years, and has not been dying, but now there's no denying it.

‘Well’, I think … as I try (with success) to quickly forget this and get on with the rest of the ward round, ‘Thank God I'm not dying …’

Reflective meditation begins where mindless distraction ends. With lights dimmed and external noise reduced to a minimum, one can observe the ceaseless flow of a mind that never seems to tire of being active.

As an object of such meditation, the certainty of death is supremely successful in challenging our most deep seated assumptions about living permanent lives in a permanent world, to which assertions pertaining to the possibility of our ‘not-being’ are as distant from our consciousness as are Mr L's blood results when I am watching this week's episode of ‘Only Fools and Horses’.

The absurdity of be-ing at all, and the questions this raises, are so expertly concealed beneath layers of (often senseless) distraction, that they are, rather sadly, never addressed, since they are never recognised. So Mr L's death is seen as an unfortunate and sad event rather than what it really is: a tragically beautiful but inevitable conclusion that lies at the heart of all phenomena.

In distraction, I find comfort and security in the illusion of permanence which, rather bizarrely, I have been responsible for concocting from the outset. Yet sadly, it is this distraction which distances me to ever greater lengths from Mr L in particular, and the rest of my patients in general. ‘Their problems’ become too distant from me for me to entertain them, while I busy myself indulging in favourite pastimes, as I listen for the sixteenth time to ‘The finish line’ by Snow Patrol.

What if I were instead to listen to my beating heart, and feel its life-sustaining actions? What if I were to focus on the miracle that is my breathing, and ask ‘what is this?’ Can I see that death doesn't only happen to others, and not only to those unnoticed old souls, ravaged by dementia, and forgetfulness; or those poverty- stricken Africans placed conveniently out of both sight and mind? Can I see that I am not ‘going to die’, but that I am, in each and every moment, engaged in the process of dying? How does this affect my relationship with Mr L?

Calm and focused awareness observes this body, its positions, the feelings, the moods which arise and fade within it's mental elements. It observes its responses, its habits. It accepts that it was born, and humbly finds itself in the same existential boat in which are all other beings, a boat which is heading towards only one destination; it notices its attachments to the world, to physical pleasures, relationships, family, friends, work.

Reflection on the certainty of death gives human interaction a refreshing air of authenticity which breaks through habitual interactions based on the confused mess of ‘wanting/ not wanting’, and generates relationships based on the only truth amidst the mass of untruths.

So I can sit with Mr L and ask him about his childhood, and about how he met his wife, and who made the first move, when they first met. I can recognise this being as a dying individual, no different from the one to whom he is speaking. I can listen to his fears, and I can be open to his tears, and his concerns. I can laugh with him, as he recalls his ‘good times’. I can recognise his impermanence, as he will, and I can recognise my impermanence. I can recognise our impermanence.

And when the time comes for Mr L to breathe his last, I can remember him fondly, and remember all that I have learned from our brief interaction.

And I will continue to push this trolley, and collect blood results hurriedly lest the consultant should get annoyed. I will continue to avoid being asked complicated medical questions by him, especially when he is in a bad mood. And with the arrival of the next abnormal blood results, and the breaking of bad news that will follow, I will remember that my role is not to offer sympathy for the suffering of a patient filled with fear, or try to fill awkward silences, but to participate in the relieving of a suffering which is ours, as together, and relentlessly, we move towards the finish line.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners