My messages Friday morning included a request from Bridie to connect today. She sounded okay in the message but this was a change in plans. And, I had a message from Dawn, cancelling. I wasn’t really surprised. Push back is not uncommon when people are put in the position where change is the only option. I pulled Kim aside after rounds and shared my idea about debrief time with her. Oddly, it was something she hadn’t thought of. She said she was touched when I asked if I could back her up for a bit while she got her heart rate down after our incident with Rick the thug. But “let me think about it” was all she offered.
Things were backed up in emerg this morning. I guess an acceleration of the pre-weekend panic before the extended weekend. To move things along a bit, I had to call up and remind the mental health unit that a patient waiting down here for a decision required a psychiatric assessment. I didn’t mean to be testy but I did add suggest it had to be today, sooner would be better, or we would be staring down a Form 1. In theory, an emergency physician can complete a Form 1 Assessment for Psychiatric Assessment at any point up to seven days after seeing someone. But when there was access to a specialist, it seemed the best way to review the situation.
I have seen a Form 1 misused as a ticket to a mental health bed, ergo ‘out of my emerg’ but the physicians at Carter are pretty reasonable about good clinical practice. Mostly they play nice in the sandbox, likely because they have learned that trying to resolve mental health problems without threat of involuntary admission is a sound practice. I dropped in to see the fella waiting for the said psychiatric assessment and explained that the psychiatrist would be here to see him at some point this morning. His mood remained very low. The dark circles under his eyes convinced me he had more on his mind that he was sharing. I left the digging to the psychiatrist but I reached over to touch his arm before I left. “It’s clear to me that you are really down.” His sad eyes met mine. “You might not believe this now but with the right supports you can recover.”
“I hope so.” Was his quiet and wistful response.
“Hope is the place to start.” I gave his arm a squeeze. “I’ll check back”.
At nine o’clock I called Dawn. No answer. I left a message asking her to call me back and enunciated my cell number clearly back to her. I noted her call in the record. Then I called Bridie. She reiterated her message about seeing me today. No details were forthcoming. When I pressed she said “I just need to work out a wrinkle with you.” As it turned out, with Dawn’s cancel, I was free at 1230. For the rest of the morning, I called Dawn every hour, repeating the same message and leaving the number. I knew it was fruitless to get into a battle with her but I had so hoped this would work out. Before I called again, on the hour, I heard Viv’s voice in my head advising: ‘who is this about anyway?’ I missed the next hourly call. At ten minutes past the hour, at 1210, Pharrell made me feel Lucky. Dawn was calling back and yes, she would be there on time. Hmmm. Now that time was filled. I rearranged to see her at 1:30, wondering what it was that had changed her mind…hoping it wasn’t the withdrawal of ‘love’ in my missing call. No more time to hypothesize now, Bridie was on her way.
Bridie was here on her own. She looked tired. She wasted no time introducing our topic for the day. “Dr. Leung is not in favour of another round of radiation.”
“Are you surprised?” I wondered aloud. “When we talked last time it sounded like you knew it wasn’t a given.”
“I’m not surprised.’ She conceded. “Just resigned. This marks the final leg.” Now I appreciated the source of her despair.
“Gottcha.” Was my simple, modestly professional, utterance resembling support.
After letting my remark burn down to ash, Bridie explained that because the first round of radiation was quite aggressive it worked very well but it also compromised the tissue surrounding the tumor. In her case, according to Dr. Leung, it weakened the bowel tissue and the mesomentum, which is basically the binding that holds everything together in her gut. “So,” Bridie expanded, “if this component of the system is already weakened, more radiation will increase the risk that it will rupture.”
“And for you this means…?”
“For me this means an unpredictable end. Maybe I literally burst a gut picking up Lynne, or getting up from the couch. Or on the toilet….” Her voice drifted off but I truly understood.
“I might get another two to three months… I might get that but I can’t trust that during that time I won’t fall down dead in front of my kids; bleeding out internally, in agony.” I nodded my head slowly, the message registering clearly.
“Your worst fear.”
“My worst fear.”
“So, where do we go from here?” I wasn’t sure if I needed the direction more than Bridie.
“I need to get ready. I think I’ve crossed the last bridge…well, the second last bridge, so to speak.”
“How far over the bridge are you right now?”
“…I have most of the videos finished. I have notes and cards ready in a folder for Doug to share with the kids at particular times, like birthdays, graduation…” She stalled. Then she resumed “I’ve spoken with Dr. Leung about pain management, he gave me some Morphine to help me get through the next while. He said to use it liberally and not let the pain get ahead of me. He explained the drip to me, once I get into the palliative bed. I can use as much of that as I need to keep me comfortable at the end, instead of the pills. And speaking of the palliative bed, I have an appointment to walk through next week – that was one of the reasons I wanted to see you today…I hear it’s a pretty good set up. Kids and family can come and go as you wish…” It sounded as though she was losing steam. Then with new resolve she continued. “I’ve met again with Reverend St. Croix. Both Doug and I met with him. He’s a good listener and he will do things the way we want…Hattie?”
“Yes?” I feared I would fail her.
“Hattie, do you think we should video the service. Do you think it would be something the kids would be interested in later, you know like when they are grown up?”
“Now you can’t just dump that one on me from the blue!” I spit out, authentically.
Bridie laughed, genuinely amused. “I know, all these thoughts are so familiar to me because I’m rolling them over all day, every day…think about it. I value your opinion. Reverend St. Croix said he will do whatever I think is best. Doug is torn but he is thinking if we don’t do it and the kids wish we had, we’ll regret it…well, I won’t regret it but he will. But if we have it and they don’t want it, it just stays on the shelf. It’s kinda along the same theme as the videos I am making for them. I want them to see them when I want them to see them but they may have other ideas. All I can do is the leg work.”
“You amaze me Bridie!”
“Ya. I’m getting pretty good at dying”. She managed to keep a straight face. “And I’ve only been at it for a few months.” Now she laughed out loud.
Impulsively I laughed along with her then corrected myself. “I guess we shouldn’t laugh…”
“What else can we do? I’m so weary of crying. And there will be lots more to come. I welcome a little laugh now and again.”
Before she left, Bridie described their upcoming visit to her mother’s home. One of Bridie’s hopes during this visit is to go through some of the old photos, put them in a scrapbook and compose a commentary for her children. “I want them to hear from me that my cousin Danny was the one who spilled turpentine on granny’s lawn not me – just because we are both standing by the bucket.”