Mr D came to see me because he had experienced a transient loss of function in his arm. During my training I had worked for a vascular neurologist, whom I greatly admired. I referred the patient to him.
When Mr D returned he had already had a brain tumour diagnosed. These two conditions can resemble each other when they first present. The tumour was not curable, but he did have radiotherapy.
He had a wife and there were two children of late school age. We prepared ourselves for terminal care. They wanted this to be at home. Despite wanting this, I could see they were nervous about what to do when he died. At a certain point I withdrew the steroids, and Mr D went downhill into stupor and coma fairly rapidly.
When I called by one day his breathing had changed in that way that precedes death. I did not have anything pressing, and decided to stay with them. Mrs D, his two children and I sat around the bed, which they had placed in the living room. In a way there is little more moving than to sit with a family and witness one of them dying.
The breathing came and went irregularly. They held him. Was he dead? No, he started breathing again and again. Death came eventually, and they cried.
I stayed and helped them make the arrangements with the undertaker.
My working life is usually so cut up into little episodes, that in a curious way, I felt really satisfied to see this through. The district nurse felt less satisfied. It's difficult with death to get things right, and easy somehow to feel left out. By some standards our practice was probably good as a team. But people working in general practice are alone much more of the time than people in hospitals, and it is lonely.
I got to know Mrs D better after her husband's death as she developed hypertension for which she saw me. She was a warm, vibrant person, and I wondered if she would marry again.
Then her daughter had a baby, and as she was a single parent, she continued to work. Mrs D took on a new life. She took over looking after her grandson, as if he were her own child.