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CMAJ. 2016 April 5; 188(6): 452.
PMCID: PMC4818144

Dear L

You died today. A Saskatchewan farm boy who volunteered to become a tail-gunner in World War II, you were the only member of your squadron to survive being shot down in a bomber. You lived through three death marches after that, along with the starvation, torture and filth of a year as a prisoner of war. You came home, worked in a grocery store and built houses, married, had children and led a quiet, decent life. Your children are good, your grandchildren love you, and there’s a picture of two of your great-grandchildren on top of your kitchen cupboard.

I met you only toward the end, when your family was struggling to make sense of your pain and with how to care for you as you grew weaker. I struggled, too. As your new family doctor, I wanted to make a brilliant diagnosis or management intervention that would ease your suffering. Nothing could undo your 94 years, but surely I could make things a little easier for you, for your wife working so hard to keep you on your feet and for your daughter whose frantic messages kept me awake with worry.

I visited you in your home and found a man, diminished but dignified, sitting in a chair surrounded by war memories. You wore a neat button-up shirt with a pair of pajama bottoms. On the TV tray in front of your recliner was a lunch from the retirement home: a thin soup, white bun and yellow custard. Old-people food that you played with rather than ate. Food was important to you. In the camps, you ate horse-head broth and stole potatoes to keep a bit of gristle on your bones. You starved. You promised yourself that if you ever got out, you would never want for food again. The soft food on your tray shocked me. More than your heart failure or kidney problems, that tray of food seemed an unjust punishment.

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It was my job to test your memory. Some things in your behaviour suggested that your memory was failing faster than anyone realized. I ran you through the battery of questions, as humiliating to me as they were to you, and when I tallied up the results and explained them to your family, I smiled to myself at how your intelligences and charisma had pulled the wool over my eyes. Despite rather advanced dementia, your grace still made you a force.

The call came on a Friday night that you’d had what would be your last heart attack. In the hospital, you worked hard at breathing. You knew me at first, though a few times I had to remind you who I was, especially when you looked at me with sudden fear. I’m not sure what I represented to you in those moments, but when I told you my name and put my hand on your shoulder, your face softened, and a cluck of your tongue told me you were disgusted with yourself for your lapse. Your grandson fed you mashed potatoes and gravy as you listened to the curling on TV, staring into middle distance as you chewed. I excused myself to go home to my kids, and I told you I’d see you in a couple of days, though secretly I hoped you might just go in your sleep.

Two days later, only an hour after talking to your daughters in my office and working through the decision to move you to hospice care, your daughter called to tell me you’d died and that they’d been there with you. I had prayed for your speedy and gentle release from suffering, but the message took my breath away. I closed my office door and cried for you. The afternoon passed wrapped in a kind of emotional cotton wool — new moms trying to learn the ropes of breastfeeding, middle-aged people receiving bad news, colleagues with their victories and gripes. I stopped for groceries on the way home, stupefied by choice and noise, wanting it all to stop for just a moment to recognize that a great man, plain and unknown, had passed, as we all would, and how in the face of that, seven different choices of walnuts seemed an abomination.

I think about you, L, how you mourned the loss of “the boys” — your crew — your entire life. I think about how dementia is like a haunting, how my first question, “Tell me about yourself,” surprised you, and how your answer — “I was in the Air Force and I was shot down” — got right to the heart of the matter, more than any talk of edema or creatinine, and how it awakened something in me toward you and made me want to do right by you, more than mere duty demanded. How it carved such a big hole when you died.

I was blessed to have known you, L. I hope the boys were with you when you died, and I hope you were feasting and young again. — Monica

Footnotes

This article has been peer reviewed.

This is a true story. The family has given consent for this story to be told.


Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association