The last Christmas — a Palliative Care reflection
I knew that it would be a difficult day. Complexity and challenge at every turn and aspect. I’d been given the opportunity to help run our Palliative Care Service for the first time, providing my boss Kirsten, a well earned Christmas and summer break with her family. It was a mixture of both terror and excitement, fulfilling work and heartbreaking cases. And little did I know that this period would be a defining moment for my practice, professional life and inner world.
We’d received a flood of referrals in the preceding week and Christmas was only a few days away. The hustle and hum throughout the hospital at this time of the year was expected, with most people getting ready for a short or long summer break and many others filled with either the joy, busyness or worries of the season.
But what does Christmas look like for a Palliative Care Service?
Well, much the same as most other acute medical teams but with one significant difference:
Many of our patients would be having their last Christmas with their families and loved ones.
And for those who'd lost a loved one in the year, it would be their first Christmas with one less person at the table.
As a dad of three young boys who were bursting with excitement and trying their best to find hidden presents around our home, the concept of a “last Christmas” was something that hadn’t been pointed out to me before.
That December we had three patients under the age of forty-two and one couple stood out to me in particular.
Becky was 41 and pretty. Her husband Max was rugged and handsome and together they were a standout couple. Max was loyal and had never left Becky’s side during her treatment. His trade business screamed to a halt overnight when she was diagnosed with advanced cancer a few years earlier. He had been at every appointment and smiled and nodded politely. He didn’t say much but let his actions speak for him. In preceding months I’d seen the change in Becky’s function — from walking down our long corridor coffee in hand, smiling and chatting, to Max needing to push Becky in a wheelchair, her skin now sallow, her frame wasted, too tired and debilitated from her relentless treatment schedule to walk.
Like many other parents with children who play a sport in a country town, I’d seen them both around. They had kids about the same age as mine at another school, a boy in the middle and two girls on either side. A perfect and wonderful life. Decent and hardworking people. Well known and well-liked. I’ve learnt that cancer is never fair.
They’d come in to discuss a permanent solution to the recurrent swelling in Becky’s abdomen due to her failing liver function. But in our meeting before the meeting, our wise Nurse Manager Lesley said something that grabbed my heart and stopped me dead in thought. Her words melted my heart and reduced me to tears.
“You know Jonathan, this will be those little kids last Christmas with their mum. We need to make sure she’s well on that day and do everything we can to help her”.
Last Christmas?!
Boom.
Crash.
Tears….
I bit my inner lip hard attempting to override what I knew my emotions were trying to produce. But it didn’t help. What Lesley said had already taken root in my heart. The tears welled in my eyes and fell thick and heavy as I tasted a rich metallic warmth in my mouth from my futile lip-biting exercise.
I swallowed and sighed and mouthed the words, “Last Christmas”.
One tear was all it took before the uneasiness of the moment crept over and enveloped me. I wasn’t quite ready to see Becky and Max just yet. It took me several more minutes to compose myself because all I could see now were the faces my three boys juxtaposed in place of Becky’s three.
My demeanour and attitude to our meeting had changed and Lesley could see that she’d hit a nerve with me. These things happen in Palliative Care, in medicine and in life. We don’t when and we don’t why, but certain words and phrases, particular patients and families and certain circumstances will break through our defences and tack on to a memory that we hold close, a value that is meaningful or will remind us of something or someone whom we love.
We see our story in theirs.
Lesley’s words brought my three boys into view.
Last Christmas.
In the blink of an eye, how much I loved them and my wife and what Christmas meant to us all overwhelmed me. I wasn’t ready to think about our last Christmas together let alone contemplate saying goodbye to them in this life.
It was a devastating thought, one that I’d never entertained before. I suddenly knew what this meant for Becky and Max. This was their last Christmas together as a family before Becky died.
I thank God for that moment of clarity because it didn’t just help to frame our appointment with Becky but it brought perspective to my practice and to my life.
Each of one us will have a first and last Christmas on either side of this life. And as my team and I have learnt this year, some lives are so short that they do not even have a Christmas on either end.
The one thing I love most about my work is that it is a reality check each day. I live and breathe the knowledge and wisdom of numbered days — for each of us has a certain number of days that we were created and destined to live.
That summer and the one that followed I changed many things in my life to help bring my thoughts into the present. To enjoy my boys growing up and to not miss a second of life with Kylie. But alas I’ve found it is never enough! I still miss significant events. I am still diverted from my mission and led astray by the false idols and shiny objects of this world. My moods rise and fall by the virtue of life around me and I am susceptible to utter devastating distraction.
It’s not perfect and it will never be. But one thing I know is that as the later weeks of December roll around each year, this may be the last Christmas for someone I love or my last Christmas in this life.
That is okay because it is madness to think we have control over the number of our days. Money, wealth, power, medical science or being a good person — nothing keeps us from the peril of disease, decay and finally death. Ask anyone who has lost a loved one this year or last — What control do we really have?
It wasn’t surprising that Becky didn’t want to have the procedure done before Christmas. She wanted to swim freely and eat a picnic lunch on the bay and not contend with another medical tube attached to her. My tears before provided me with a lifetime of understanding of where she was coming from. We made sure that she had enough pain relief and anti-nausea medications to enjoy a hearty lunch and play with her kids and we wished them both a Merry Christmas. And to my team and me, those words “Merry Christmas” are never throwaway greetings or platitudes. They mean something to every one of our patients and their families at this time of the year.
So this Christmas, let the wisdom of the season be your guide. We only have a certain number of Christmas’s with our children, with our spouses and with those whom we hold close. We live in a world that is unfair and in bodies that are frail vessels.
This isn’t meant to be a sad piece but rather one that encourages you to live in the moment with love and gratitude for those sitting and not sitting around your Christmas table this year.
I understand that Christmas can be angst-filled or Christmas can be lonely. I get that Christmas can be stressful or Christmas can have a sour legacy. But whatever happens this season, I encourage you to snap a picture in your mind of the moment, for time never replicates itself perfectly and memories are all that we have.
“I’ve learned to cherish every moment,
Cause moments don’t slow down to please the heart,
That’s what makes it hard
….I wish that time would slow down”Almond Eyes: Brandon Lake
I am sure that the clarity and presence of mind that Becky and Max shared with their children and family that Christmas was precise and undistracted and above the pettiness of life.
So this year, invite over Christmas orphan for a meal, make the call that you’ve been meaning to, give someone you love an extra long hug and take a deep breath in and experience living in this wonderful and beautiful and most precious moment of time.
For me, this is the time of the year that I celebrate the birth of Jesus who offers us all new life. Life beyond this life and a life that is worth living and dying for each day. This is the Good News of the Gospel. And this is my hope in this frail, fragile but beautiful world.
Merry Christmas everyone and thank you for your reading support this year.
Jonathan Ramachenderan
@thehealthygp
Live intentionally.
Love relentlessly.
Enjoy your health.
