Today I had the absolute privilege of attending the APMJ, the Annual Palliative Medicine Junior Doctors’ Conference, at King’s College London, after I submitted a winning short story entry on the topic of ‘Grief’.  I had met some incredible and inspirational delegates and speakers over the course of the day, most of whom were either just about to start the specialisation phase of their doctor training, or were already consultants concreted in the fascinating field of medicine that is Palliative Care.  And it was simply yet stunningly insightful to hear their reasoning behind the field, and its advances.  Naturally, in return, it popped up in question the motives and reasoning behind my story that I had submitted, but I had no particularly long-winded or unique process when putting it, other than I wrote it, on my phone, in a deep bubble bath, whilst I was having a particularly down day.  Grief, had got to me in such a way that it caused me to offload a thesaurus of emotions in this conveniently timely fashion, perhaps a little more easily than usual.  Nothing more.

But, what was perhaps most striking, in line with the above, was the opening speech of today’s conference, given by Dr. Mark Taubert, a consultant in Palliative Medicine.  When telling the rest of us the tale of when a simple tweet shortly following his fan, David Bowie’s, death, was then retweeted by David Bowie’s son, and then quickly spread worldwide – the topic surrounding the concept of death and dying, had suddenly become a phenomenal topic of conversation on the world of social media.  This was without doubt a breakthrough for the world of Palliative Medicine, particularly as we still very much try to fight off the taboo of death and dying to this day.  The world had become bewildered, and eagerly curious, to Dr. Taubert’s comment, because there was a story behind it – human meaning.  Whilst  delivering his eye-opening talk on this topic, Dr. Taubert also reminded us that, whilst the presentation packed with data and quantitative evidence-based platforms sends us only half-aware and disinterested, the story, the tale, on the other hand, never fails to capture an audience, because truthfully, people love people – human cause is so much more identifiable and relatable than any numerical dilemma.

And this is perhaps one of the many reasons why I too, am routing towards specialising in a career of Palliative Medicine.  Not that long ago, I was sat down by a doctor I was working alongside whilst on a placement block, who proceeded to ask if I had any ideas of what I might like to specialise in.  With my confident response of Palliative Medicine, the consultant only laughed and spluttered at me, exclaiming that I would never make it as a Palliative Medicine consultant with a visual and hearing impairment, and that if it was because this field was more manageable and realistic for “someone like me”, then I couldn’t be more entirely wrong.  Thing is, that wasn’t even the reason…

The reason I truly want to follow a career into Palliative Medicine is because I love people.  I love life stories.  Add these two together, and you really recreate a meaningful basis behind every type of human being – our patients.  With a story and a life, or part of a life, we can help put the human equation together to recreate an individualised, holistic treatment and management plan for the dying, or terminally-ill patient.  What’s more, we can all offer this empathy in that situation.  We don’t have to be dying in this instance to relate to the story – we all have a life story beneath us – as will every single person, everywhere we go.

My own personal brush with death, perhaps on a little too many occasions, but more specifically to my most recent life event, made me think about this whole concept far more deeply than ever before.  I had genuinely had to contemplate the feeling of having to eventually let go, to leave my loved ones and to fade out, with absolutely no control over that process, being too poorly to rationalise or justify the matter.  My family too, were beginning to prepare themselves for the possibility of this “D word”, as referred to by Dr. Kathryn Mannix, in the closing speech of today’s talks.  My life story was to end and their life story was to soon take a very sharp bend round the opposite corner.  And begin, again.  But I stayed to tell the tale, and that tale I submitted in the form of this conference’s ‘Grief’ booklet.  I was one of the lucky ones.  Lucky, in more than one kind of form.

What to take away from this is to start from the beginning, and follow the chapter through.  Don’t make assumptions and don’t bypass the blurb.  So many things we put a number or percentage to these days that we forget the quality of what makes a story – the qualitative definition to a life.  Listen to others, embrace their chapter, and then add yours.  And only then, as with every other book, life, there is closure, an ending, and that’s when we can reflect and learn the most.  But it’s also accepting that there is an end and that end, or summary, should be shared with the rest of us, just how I am sharing you my perspective on ‘Grief’.  By sharing this slice of my life story, I am tying it into a metaphorical closure which I can only appreciate and learn from.  Because that’s what makes the most powerful story…

Every Kind of Grief

“Apple-eyed, she scoured the moss-rot, rolling in the honey grass that bleached in a jaded sweat, before springing back up and hastily ushering off the mud-cake squelch that deliciously draped up her bare and unscathed thighs.  Then, with the look of cheek, a sparkle in her eye, she grinned back at us before running into the still silver water.  It was like something wonderful had broken our careful silence, as she splashed the mud off her, now a porridge-like dirt streaming down her cold-pink limbs, bathing the now-glistening gash at the side of her foot, blood so brilliantly fresh-red.  She shrieked.  Beautifully.  So beautifully that the heathers and pondweeds all around us frolicked in an excited tingle.  She ran back out of the water, ducking in and out of the bushes as we giggled from where we were perching.  The drenched lilac saps were studded a granite blue, pink icicles dripping warmly as she ran, brushing her fingertips curiously along the tall, sticky spring grass, her infectious cackles losing themselves in the thick film of the warming air.  Boisterous and care-free, she was. 

    You can still see those hills where the water stood, dribbling into each other so uniformly, in blends of gooey greens and bouncy blues.  In between was sutured by the partition of an old wicker fence, and further on, drafted out by the proud territory of perhaps a couple dozen of oak trees, their luscious green leaves blotching a young skyline.  And, before your eyes wander this skyline, there comes across a single photo frame, rectangular in shape, simple yet so untold, resting on my Papa’s windowsill back in the house.  Five fresh, smiling faces, all with teeth like off-white pearls, the manes of many white-backed horses, stains of story, decades shared together over red wine and Christmas dinners.  Our dimples all so clean and well-dented. 

    Every day childhood was so different.  Yet, on each and every day I was taught something new.  I was lifted up so buoyantly, like their little sunbeam, a single soft and innocent flame, newly burning for an incessant thirst of knowledge, care, protection, and love.  Looking back, it was almost as though they never wanted me to leave their bubble, too anxious that I’d get hurt, or that the beast of the working world would swallow me up into the void that we call reality.  A world governed by the survival of the fittest, where the laws of health and wellbeing takes no prisoners.  But, like her, there was no need to care back then. 

 Three weeks in Intensive Care, thirteen days on a ventilator, septic and delirious.  I was ravaged by what I can only describe as a horrific dream, nightmarishly fragile, where I became stuck in a lonely dimension that became timeless, and where the judgment and control of giving up entirely was completely separated from mind and body.  It was also completely and indefinitely real.  The brushstroke away from breathing life was painted.  Countlessly. 

    ITU was stuffy, stale and clinical.  Impossible to distinguish between night and day, the low buzzing lights were the only visible fume that whirred toxically as my limp eyelids were pressed open momentarily, medical staff scurrying in a hushed panic around me.  When potent intravenous sedation was still not enough, the only alternative was to be struck out cold with a surgical anaesthetic gas, for 4 days, whilst typically it is not allowed for any longer than a few hours.  The liver and kidney numbers plummeted and my blood pressure was the metaphorical equivalent to the sinking Titanic.  My parents were bombarded with a hefty wafer of jargon – the paperwork of consent to sign for an emergency tracheostomy.  That was if we even made it to that stage at all.  Or even they.  Just a few hours earlier, the force of unconditional love had driven them 950 miles over to Italy where I lay, only to obliviously cross a landmark bridge to Genoa, that crumbled, its black hole of destruction taking the lives of 43 innocent people just three hours later.  Talk about close calls. 

    A respiratory arrest soon sent thick fluid onto the lungs, followed by what felt like a lifetime of dysphonia, my pharynx visible quivering as they flapped pathetically, unable to control any form of swallow, only choking and spluttering more, the rattles under the breastbone cursing me like a death-drum, a deep venous blue.  The frustration of not being able to communicate was exhaustive, only ever being able to manage an “I – I – I…”, before a ravenous brain fog swooped out all my efforts.  I stared at my parents, and I stared at them, for a very, very long time.  Was it love?  Or was it confusion?  I could not put name to face, or face to name.  My mum was unrecognisable, my dad was a complete stranger.  It was the year 2024 and my age and date of birth were now a long lost memory.  I no longer knew my own skin.  But this nature of evil ceased to stop consuming.  Infection markers were screaming, yet the source was a needle in a jungle.  The hospital bedsheets burnt my skin. 

    But, it was arguably the hallucinations that left the worst scar of all, an apparently common encounter experienced in longer-term ITU patients.  It had sent me hanging off the edge of buildings for days, in plane crashes, packed up in tiny boxes, and even sleeping outside.  Then the worst night came.  Over the course of the evening, the lights had grown deadly white, heavenly clinical, sharp and frosted.  My body felt packed.  I turned a beefy kind of swollen, and the ports where my central line was strung pierced in agony.  I was ice.  But I was a floating sort of ice, dreamy.  In the near distance I could hear a chorus of sobs.  But I felt so at ease I had almost lost the care, the responsibility, the reminder to lift my own ribcage and exhale.  Was this it?  This was actually it.  I was leaving this world.  And I couldn’t do anything about it, other than to lay there and accept, paralytic to the sounds of other people, people of whom I’d loved, mourn. 

    That death was without doubt the one trauma that still hides in me to this day.  It was a hallucination like no other, yet still so vivid every time I try to get an early night’s sleep for another early morning placement the next day.  But this grief was something else.  Not the grief that you yourself are going, not the inconsolable misunderstanding of “why me?” “why now?”, but the grief of wondering exactly how anyone could have the strength, the courage, the bravery, to leave behind the ones they love most.  Because if that is the case, it made me feel cowardly, guilty.  I was way too scared to let go of them, those five smiling faces with perfectly dimpled smiles.  My family. 

 I still gaze beyond those hills today.  Only, the autumnal sun is now just a pale withered moonbeam, resting on the weathered skyline, the haze of lavender flocks jaundiced yellow, the reeking dandelions flagging over amidst the dew-sunken stench.  The water is still still, perhaps a little more still than before, hairs of silver rippling occasionally, boats of smooth, fresh-splintered coffin-wood rocking side to side.  In the woodland beyond, blackcurrant globules bleed, slobbered and milked, the burnt bluebottle crisps famished on the slippery tweed as their corpses lay juiced in the suffocating heat that was summoned by such an emotionally chaotic summer.  The air had become treacle-thick, making it hard to breathe as freely, the dust of steel fairies – a remnant of cremated dandelions, drowning.  Fluff-thistle bronzed, the crowned corn-heads flaked like dry pastries, drier than her skin when I look back.  And when the chorus came, the singing boughs creaked flu, just how she did.  Twinkle-cursed and stale. 

    And, as I gaze back on those hills, the pink icicles defrosted, the fields lucid and sallow, I come across a single photograph, rectangular in shape, simple yet so untold.  Back in the field hums a beautiful shriek, a wind moan.  Papa doesn’t remember much of that now, but two smiling faces look back at us, through a thin coat of silky dust, their teeth like off-white pearls, dimples clean and well-dented.  I stoop down to a chair, still clutching onto the photograph, my calf muscles now only two single bones, wasted, trembling as I desperately try to regain my strength after that awful summer, my inner scars far deeper and more bloodied than those outside.  I brush my finger across the cool glass before stopping at three more smiling faces – all now lost.  All in one year.  My auntie, to breast cancer.  My uncle, to lung cancer.  And her.  My grandma.  Brittle asthma, emphysema…She had my lungs. 

 I slide my finger back again, until it squeaks clean, my smile a crease.  My crease a smile.  Inside, all those scars now bleed into each other, that grief no longer a small lost flame but a raging fire of determination.  To get better and to give back.  Now a medical student, then a patient, to be a palliative care physician.  And then, when I look back up, carefully placing the photograph back on the windowsill, I gaze ahead and see one lone oak tree, waiting bravely in the wind”.