I don't think I'd ever felt more ashamed. The story would feel familiar to all active palliative clinicians. A fifty-something-year-old man was dying of pancreatic cancer. Previously fit, he was still able to get in and out of a wheelchair. It had been five days since his wife and young daughter had visited him. They weren't allowed to because they were close COVID contacts, though were themselves PCR negative. He spoke to them over Skype and while rounding we thought “at least he has that.”
His friends wanted to take him out for a coffee by the river. The hospital was in lockdown. He asked to be exempt. We told him “No, but you could ignore us. Nobody watches you when they wheel you to the hospital garden. Who'd stop you going further?”
The coffee and company and riverside views did him good. I was pleased by our cunning though I see now it was cowardice. Upton Sinclair was right, it is difficult to get a man to understand something when his salary depends on not understanding it (Sinclair, Reference Sinclair1935). A dying man must be permitted to hold his wife and daughter, I understand that now.
I call this post-modern palliation because post-modernism rejects enduring truths. On post-modernism, some may judge his death as tragic and others as acceptable. It just depends on one's point of view. Does anyone believe this?
Some middle-manager spoke to me. I told them the case was abominable. They nodded empathetically and said “I can definitely see how you would feel that way, given your job. I understand your point of view. They may be able to meet with him for 15 minutes in the ambulance bay if they wear full protective equipment. Let me see what I can do.” These were their words and then they smiled, thinking they'd made things better. That a dying father should stroke his daughter's hair one last time is a “point of view,” and the last time he holds her hand and feels latex instead of skin is worth a smile. My disgust was a man's disgust, not a physician's. The manager was not a bad person but they were mistaken.
Perhaps all this is necessary. Would it be better if some other clinician was writing about the deaths that could have been avoided if the hospital had just enforced lockdown measures? There are plenty of lives which could be extended if the palliative ward was converted to a dialysis unit. To say he received good palliative care because someone was moistening his mouth and adjusting his analgesia is disingenuous. He died alone and that's what his daughter will remember: a man on a screen who wouldn't wake up. He won't remember even that, so perhaps it's of no consequence.
This isn't a commentary on lockdown policy but merely one palliative physician's reflection on one effect of that policy. I'm not sure what the correct policy is nor do I think I should decide it. Tocqueville thought priests were both so important and so at risk of being corrupted by power that he would “…rather shut up the priesthood within the sanctuary than allow them to step beyond it (de Tocqueville, Reference de Tocqueville and Bowen1863).” Not religious myself, I recognize there is nothing meek about “Thou shalt…” whereas we often write in the passive voice, mere observers of truth working increasingly under a paradigm which rejects the notion.
I don't want to practise post-modern palliative care. I don't think my colleagues want to either. If I must, I hope I have the decency to feel ashamed instead of justifying it with sophistry. I was tempted to finish by quoting Donne, but opted instead for a lesser-known poet published in a palliative medicine journal (Davis, Reference Davis2020). After all, a man is no more an island than he is the Wanaka Tree.
I could not distance myself from the forest,
Nor tree can from tree.
For they are rooted one to another
To sing, limbs outstretched to wind's choirmaster call.
And together ground suckling the soft brown breasted earth,
Spring renewed to life's green.
Here is where I belong, this moment, now.
A tree standing alone is a curiosity. A forest humbles us and within it we are visitors, not spectators. Dying alone with spectators watching from afar is as awful now as it will be a thousand years hence.
