Working as a palliative-care doctor

As a junior doctor, I worked at Bethlehem Hospice in Melbourne. When patients arrived at the hospice, they knew there was only one way out. Most of them had a terminal cancer or end-stage organ failure, and were simply waiting for the inevitable, hoping that the end would be comfortable and the transition without undue suffering.

My job was to admit the patients, write up their drug chart, and formulate a plan after conferring with the consultant. This gave me the opportunity of taking a social and family history. I was genuinely interested in people’s life stories; I wanted to know how they lived and how they were approaching death.

What became very clear to me was that in most cases each patient went through the dying process in a very similar way to how they lived. Those who had lived in fear generally died in fear, while those who had lived contented lives often died in peace. This was often, but not always, the case.

I distinctly remember a sister of the church, Francis Mary (name changed). She had terminal stomach cancer and was in constant pain, but she always had a smile on her face and a caring disposition. Every morning without fail she would ask me, ‘How are you, doctor?’

I was at her bedside when she slipped into a coma. Her breathing became progressively slower and raspier, but at no stage did that pleasant smile disappear. I watched the rise and fall of her chest. Each time she exhaled, I thought it would be her last breath. She continued to take shorter and shallower inhalations, until eventually she stopped. Finally she was at peace. Everything became silent and I felt as though the universe had stopped to witness a great passing. I gazed at her face, marvelling that her serene smile had not diminished at all.