Sarah was 29 years old and arrived with her mother. I’d last seen her for her postnatal check a few months before, when she attended with her new baby son, 4 year old daughter and doting husband. Mark was 35 and together they made the perfect nuclear family.
I’d seen Mark a few weeks earlier, with a worrying set of neurological symptoms and had referred him urgently to the local neurologist; I hadn’t heard back yet following his appointment.
As soon as she entered my room, Sarah collapsed into the chair and burst into tears. Her mother held her whilst she keened, like I’d only seen Muslim women do, after the loss of a loved one. Between sobs, she managed to tell me that the neurologist had told Mark that he had Motor Neurone Disease. My worst fears realized………
I held her hand as she wailed and told her that I would be there for them both, that we would get through it, that hope was not lost, that we needed to be strong for Mark. All the time I was struggling to keep my voice from breaking and keep the tears from my eyes. I had never seen such raw grief.
For the first time in a long time, I needed timeout after the consultation. A chance to regain my composure, reapply the professional veneer, time to prepare for the next ‘10 minute’ consultation.
Roll time forward 4 years………
This time the consultation was in their own home. I had come to discuss end of life care. We sat, Sarah, Mark and I, discussing the probable mechanism of his death, where he wanted to die, how he wanted to die, still a young couple, with a young family, but with no family future.
“How do you do this?” Mark asked. ‘How do you cope with these kind of conversations week on week?” It was humbling; we were discussing his death after all, not my job requirements. “Somehow you just do”, I said. “Somehow you just learn to separate your own emotions, otherwise you wouldn’t be able to do the job. There have only been two occasions in my career when I’ve not been able to hold the act together,” I said, “when the pain was too much for me too”.
Sarah looked at me. “One of those times was with me, wasn’t it?” she said. I looked at her startled. “I remember it as if it were yesterday”, she said. “I could see you struggling not to cry and I thought God if my doctor is crying, it must be bad, really bad. I needed you to be strong then, strong for me…………”