The following is an excerpt from The Surprising Lives of Small Town Doctors, edited by Dr. Paul Dhillon and published by the University of Regina Press. Dhillon contributed this chapter from Saskatchewan.
Dying here, far from any building over two storeys, is very different than dying in the city.
Death is closer here, more intimate. The drive to work along a lonely grey road is not only marked by a yellow meridian but also by the red of road kill. I don’t remember seeing any road kill in Regina’s city centre when I was training.
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In Regina, we had an incredible palliative care team to refer to, people to call when we knew that any medicine we had was not going to heal anymore. Out here, they were going to have to call me.
My first real job. Thirteen years since high school — in training, in hospitals, in books. All of a sudden at 8 a.m. tomorrow morning I would suddenly become Dr. Dhillon. Time to heal and fix.
I began my first real posting as a rural physician in a small town in rural Saskatchewan. A beautiful little hospital, staff happy to see a young doctor in town, and the welcoming red and green of the local Co-op sign.
The day began innocuously enough: morning rounds at the hospital, learning about all the patients who had been handed over to my care for the next two weeks; trying to decipher other physicians’ illegible writing and promising to never let mine get that bad, and failing quickly at that.
“Hello, good morning. My name is Dr. Dhillon and I’ll be keeping an eye on you for the next little while until your doctor is back.”
With a vague idea of what was actually happening inside each patient’s body, and not a clue what was happening in their minds, I popped in from room to room as cheerful as I could be while making a list of things to check and recheck after the morning ward round was done.
Thankfully, the nurses were there to handle any miscues and give me a vital, two-to-three-sentence summary of the patient and any concerns before entering into their realm with a quick knock on a half-opened door.
When I got to the last patient I was to see that morning, I found his door was closed. It was at the back corner of the hospital.
It was darker.
“This is Gary, he’s dying.”
The nurse’s tone of voice lowered, naturally, to the level we use when discussing death, just in case death was nearby and would hear and come hither to hasten the process.
“Metastatic, it was too late when he came in. Really sad story. He’s still so young.”
Thinking back, I don’t know exactly how I felt when I reached for the institutionally grey doorknob. I probably felt pretty grey.
They don’t really tell you how you’re supposed to talk to someone for the first time when all you know about them is their first name and roughly where the first cell went berserk and started its new life as a cancer that would take their life away.
“Hello Gary, how are you this morning?” is what I said.
“Hello, who are you?” he asked.
Within that three seconds, I had seen his distended abdomen (ascities — check), nasal cannula (difficulty breathing, pressure from the abdominal fluid?), yellow skin (bilirubin overload), yellow sclera (… it’s bad), and dark, dark, almost-orange urine (this is really bad, he’s a great case for a medical student to see).
All that I had been trained to think and see, diagnose and cure wasn’t going to help me now.
“My name is Paul and I’ll be your doctor until your normal doctor comes back.”
What was I going to doctor in his case?
“I’m leaving on Tuesday. Next week. To be closer to home,” he said.
“That’s great. So that’s something to look forward to then.”
Inside, I wondered, was that even appropriate to say?
The nursing staff didn’t have any new concerns, and he was eating and pain-free on his current medications, so we ended our morning chat and I went off to the clinic to finish off the rest of the day.
I couldn’t stop thinking about him, though. Was there anything I could do to make him better? More comfortable? Was there anything I was missing?
As a new doctor, and still scared of missing something or making some mistake, I would do rounds twice a day. The nurses and staff probably thought it was very conscientious of me, but it was more out of fear of missing something that I shouldn’t have.
Over the next week, our talks extended.
I was able to meet his family, his children. From conversations overheard while walking in the hallways, from nursing staff handovers, a picture of a life emerged. Not just a yellowed man dying in a wheelchair who couldn’t breathe; a picture of a man who was battling against something completely foreign to him.
A man that had his life enter the twists and turns that occur in all our lives, but in his case, the road stopped much too early.
It was a week later, on a quiet Monday morning, that I noted his birthday was the following day.
His last birthday ever.
We physicians are notoriously bad at predicting death. But I knew in this case.
Through our conversations, I had the sense that he would appreciate a birthday cake. He was a farmer before fighting the unseen cancer cells that had become his full-time occupation. It could be that he had not had a proper birthday cake in years. He would have been too busy harvesting to take time for something like that.
He had time now. But not that much time.
I went quickly to the local Co-op after work. I needed a birthday cake, stat. How do you explain that you need a cake redecorated tonight, in the last hours the store is open, for someone who is going to die but has a birthday tomorrow, without sounding like a complete weirdo?
Also, don’t forget that you want to decorate the cake with small plastic farm animals to remind him of home and work and the happy times in his life.
It can’t be that hard to find that sort of thing in small-town Saskatchewan at 6 p.m. on a Monday evening? Right?
Somehow, it all worked out.
On the rainy morning of his birthday, I was able to collect a number of the nurses, light some candles, and walk into his room to see a look first of confusion, then surprise on his face, and then a smile that for a moment wiped the disease from the room and replaced it with pure happiness.
I left before having a chance to try the cake with him and his family, but I stuck my head in the door that afternoon. I knew, he knew, that he was leaving.
“Thanks, Doc, that was the best cake I have ever had. It was amazing.”
He’ll never know how those words made me feel. There was nothing years of training could have taught me to have made that situation any better for him medically. But I would like to think I made him a little happier.
His friend told me afterward in the hallway that he was happy all day.
Then he was gone.
Dr. Dhillon is based in Regina but practises medicine in remote communities in Saskatchewan. He completed his medical degree at the Royal College of Surgeons in Ireland and a master’s degree in disaster medicine in Italy and has worked as a physician in an Ebola treatment centre in Sierra Leone.
