I never met Joan, but she was the favourite aunt of one of my close friends, and she died recently. My friend will miss her; he told me she was young at heart, had a wicked sense of humour, and always had a twinkle in her eye. She was loved by all her family—everyone's favourite aunt. She had lived by the seaside and had a happy life—but she grew old, as we all must, and, finally, she was admitted to one of the local district hospitals ill and anaemic.
It was clear she had some form of advanced malignancy, and an oncology opinion was needed. As is often the way, however, it was Friday afternoon and the oncologist was not on site. He therefore arranged to see her on Monday. The inevitable happened over the weekend, and Auntie Joan died with no definite diagnosis, though it was undoubtedly cancer. Despite her age, her family was left distressed, missing that crucial reassurance from an expert that everything possible had been done.
Of course, nothing could have been done. What was humbling was that my friend was sure that, had the oncologist been me, I would have gone to see her. Regrettably, I am quite sure that, after a busy week, had I been on another site, I would not have made a special trip either. My friend was also sure that a few skilful and kind words would have made his cherished aunt's sudden death more bearable. Surely not a lot to ask.
I wonder if I might have gone10 years ago, but I am probably fooling myself. Certainly now it is not possible to provide this level of service, and maybe it never was. Today, departmental guidelines do not permit us to admit anyone to a cancer centre for assessment; a plan to treat actively is required. Under any protocol, an elderly anaemic lady with advanced malignancy is not an oncological emergency requiring urgent assessment, especially if she is 20 miles away in another hospital. This is particularly so on a Friday afternoon, after a week of busy clinics, correcting press and internet misinformation, attending governance meetings, and travelling to multidisciplinary team meetings. Even if anyone had gone, there was clearly no effective treatment that could have been offered.
Yet, despite all our protocols and guidelines, this was still an opportunity to show compassion that was missed. Why else, after all, are we doctors? Auntie Joan was not just an elderly patient with incurable malignancy, she was a key family member, too ill by then to show much of the sparkle that endeared her so much to her family.
Will I go the next time I am contacted in similar circumstances? I don't know. Would you? If we do, Auntie Joan will certainly have been a memorable patient.
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