The last time I saw her before she died I was surprised by her desire to live. I had met her doctor at the lifts on the way into the ward. 'I doubt that she'll make it through the week,' she said. The deep red blood in the bag suspended over her bed would turn her parchment skin pink but we knew that the next crisis might be the last. She held my hand and pulled me down to her to kiss me on the cheek.
'I have a feeling that I'll be much better tomorrow,' she said. Tears welled in her eyes. 'I'm very tired though. The blood only lasts a few days and then I'm back to where I started.' A nurse entered the room and adjusted the flow rate of the transfusion. I made my apologies and caught a taxi to the airport.
Fifteen years earlier my mother had died in the same bed and it had been Theresa who met me at the lifts with the news. She was in tears then too. She cried whenever anybody on her haematology ward died but, I liked to believe, she cried especially for my mother.
Theresa was a short woman with an enormous bosom that, through the layers of her habit, had comforted countless crying babies. She had a bad back and held herself stiff and upright. She hosted the weekly Alcoholics Anonymous meetings at the hospital but she drank a sherry each evening and she loved bright and cheerful company.
She was strict but she knew that the younger staff nurses needed latitude and she allowed some innovation and limited democracy. She was tolerant of young medical residents because, having worked with several generations of them, she knew that they usually grew into wiser doctors.
She was prayerful but not pious and the occasional profanity escaped her lips. Her faith was simple but its certainty kept many of us from making the final break with belief. We loved her because she acknowledged that caring for unlovable people was hard: she channelled our anger away from the patients without denying us the right to feel it.
Theresa taught me many things. One day I had told an elderly man that the cancer in his lungs had spread to his bones and I felt that in relating his prognosis I had managed to find the delicate balance between hope and hard reality. Theresa took me aside later that day and told me that the patient felt sorry for me, having witnessed my distress in conveying the bad news to him. 'Remember, this isn't about you,' she told me.
She taught me that it was impossible to tell someone how long they were going to live. Patients put considerable pressure on you to give them a specific time — a mother needs to make plans for her family, an estranged son may wish to reconcile himself with his father — but a number will almost always be wrong. The family of the patient whom you have told has three months to live will resent it when their father dies in three weeks and the patient who lives for six months after being given three may derive false hope of a cure.
Our job, she said, is to prepare patients and families for the weeks and months ahead, to inform them of the likely process of death and, hardest of all to convey humanely, its inevitability.
Then, in one of those commonplace medical ironies, she was diagnosed with an indolent but incurable bone marrow disease. In her last year she was unable to go a week without a blood transfusion.
A few months before she died, she invited me to her convent across the road from the hospital. I had never been past the ground-floor sitting room where the nuns received their visitors. But this day she asked me to follow her up the stairs.
Her tiny room contained a narrow bed, made up with hospital linen and blankets. There was a crucifix above the door and a hand basin in the corner. This was where she had lived for over 30 years. Her window overlooked a back street lined with parked cars but no trees; a draught rushed under the gap between the door and the linoleum floor. We stayed for a minute or two, then she led me out and down the stairs without any discussion.
Today there are almost no nuns left in the hospitals to provide this kind of mentorship, to create a philosophy of practice that is lived, not written down in unread mission statements. Modern hospital management theory recognises the importance of workplace 'culture' but it is singularly unsuccessful in knowing how to create one that works for the sick. We knew how to do it once. But we seem to have forgotten.
LINK:
Catholic Health Australia
Frank Bowden is an infectious diseases physician and Professor of Medicine at the Australian National University Medical School in Canberra. In addition to his academic writing he is a regular book reviewer for the Canberra Times.