Sally’s last words: You have eased my passage, thanks a million

“And where is your husband?” I asked Sally. Having finished examining her, I thought that he could be a source of comfort, if he was by her side, when I disclosed her dismal diagnosis to her.

Saturday February 20 2016

“And where is your husband?” I asked Sally.

“And where is your husband?” I asked Sally. Having finished examining her, I thought that he could be a source of comfort, if he was by her side, when I disclosed her dismal diagnosis to her. 

By Yusuf K. Dawood
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“And where is your husband?” I asked Sally. Having finished examining her, I thought that he could be a source of comfort, if he was by her side, when I disclosed her dismal diagnosis to her.

“I have no husband,” Sally replied.

“Are you serious?” I said as I flicked the pages of her old file and went over it carefully again.

Sally had come to see me first, five years earlier, with a large hernia in her Caesarean scar. Her obstetrician, Dr Kisia, who had referred her to me, had said on the phone, when he

booked an appointment for her with my secretary: “The lady I am sending to you and her husband waited a long time before they could have children. Then, as if to compensate for

the delay, Sally had a twin pregnancy.”

Dr Kisia continued. “At 37, I knew she would have difficulty in delivering the twins vaginally.  There were also some problems with the lie of the twins and therefore, after consulting

the couple, I decided to do an elective Caesarean. That was four years ago. She has now come to see me with a large bulge in her scar, which I am sure is an incisional hernia.” Dr

Kisia meant a hernia which is a result of weakness in the abdominal wall because of previous surgery.

I remembered meeting Sally’s husband on that occasion. I had also inquired about the twins when Vincent replied: “More by good luck than good management, we produced a boy

and a girl – Justin and Joanna. Since we wanted only one son and one daughter, the shutters came down after they were born!” The name of the husband and the reply were etched in

my memory because of his wit. Just to make sure that my memory was not playing tricks on me, I went page by page in Sally’s file and, in fact, came across the actual comment

which had tickled me pink.

After watching me rustle her file, Sally said: “You are right. I did have a husband when I came to see you for my incisional hernia, but I have no husband now.”

“How come?”

“You remember I was in the hospital for a week at that time?”

“Yes.”

“When I went home, I found Vincent a changed man.”

“In what way?”

“He had formed a new relationship.”

“I am sorry. I hope it was not your hospitalisation which caused it.”

“Not really,” Sally replied looking wistful. “Things were not the same since the twins arrived. They took a lot of my time and attention. Then to make matters worse, I got an early and

difficult menopause, which did not help. So my hospitalisation was perhaps the trigger, the last straw on the camel’s back. When I went home after surgery, Vincent told me that he

did not love me any more and, without much ado, moved out of the house.”

“Oh!” I gasped. “Did you part as friends?” I asked.

“Yes,” replied Sally. “At least he was candid and not deceptive; he did not carry on behind my back.”

“Who got the twins?” I asked.

“I did.” 

FLUMMOXED

I was totally flummoxed by this information because I knew what I was going to tell Sally was devastating and would have preferred Vincent beside her.

This time Sally had not come through Dr Kisia. She had developed severe tummy ache the previous night and had been brought by a neighbour to the Accident & Emergency.

In view of her Caesarean and hernia repair, the doctor on duty thought that she had formed painful adhesions. It is a condition in which intestines get stuck to each other as a result of

repeated surgery and give pain and sometimes intestinal obstruction. On that basis, the doctor gave Sally an anti-spasmodic injection and arranged for her to see me urgently. Sadly,

my examination revealed a different picture; I found evidence of fluid in Sally’s abdomen, an ominous sign at her age.

“Tell me what it is,” Sally said seeing the dilemma on my face. “I can take it.”

“Okay,” I said still treading softly. “We need to do some investigations.”

“Like what?”

“Ultra-sound of the abdomen for one.”

“And what else?” Sally sounded relentless.

“I would like to aspirate some fluid from your belly and send it for cytology.”

“I presume cytology means looking at the nature of the cells. What are you trying to find?”

“Why don’t we wait till we get the report?” I said trying to hedge the question.

The microscopy on the blood stained fluid, foreboding by itself, showed cancer cells suggestive of ovarian malignancy and ultra-sound showed a mass in relation to the left ovary.

SAD DEVELOPMENTS

I rang Dr Kisia and informed him of the unhappy developments, because they strictly fell within his specialty.

We both saw Sally together to counsel her. Two days later, I received a phone call from Vincent. “Do you remember me?” he asked.

“Of course I do,” I replied.

“I wonder if my girlfriend and I can come and see you,” he asked.

“In connection with what?”

“With regard to my wife.”

“I understand that you have separated from Sally; I may not be able to divulge medical details about her,” I warned him.

“No problem,”  Vincent replied.

Two days later, he and his girlfriend were in my office. Vincent had not changed much. As expected, the girlfriend was younger than Sally and more glamorous.

“This is Eunice,” Vincent introduced the young lady to me. “Sally rang me and gave me a detailed version of what you and Dr Kisia had told her. Considering her poor outlook, I put Eunice in the picture and we both decided to come and see you.”

As I raised my puzzled eyebrows, Eunice added. “We want to see how we can help her. How long have we got?”

In view of the good feelings the couple exhibited, I decided to bend the rules of confidentiality. Also, I reckoned, Sally was still Vincent’s wife. “Very difficult to quantify, but we must

think in terms of weeks and months,” I replied cautiously.

“I would like to look after Sally, for the little time that you give her, if I am allowed to. I would also like to get to know the twins and assure Sally that they will be looked after.”

Eunice lisped slightly as she expressed those noble and valiant sentiments.

“And how do you intend to go about it?” I asked.

“Now that we have seen you and know her prognosis for certain, we will see Sally,” Vincent came in.

“I have never met Sally face to face,” Eunice added. “My feminine instincts tell me that she and the twins need emotional support, love and help. I think I can give them all they need

and make amends for what happened in the past.”

“Good luck to you,” I said as I saw them out.

A week later, I received a message from Sally that she wanted to see me alone. “After you and Dr Kisia gave me full details of my illness, I rang Vincent.”

Sally sat me on a chair by the side of her bed and told me her side of the story. Then, as if to justify her action, she explained: “After all he is the father of my twins and he should

know. He rang me the next day and asked me if he and Eunice could come and see me. ‘What on earth do you want to bring Eunice for after she stole my husband?’ I asked Vincent.

“Let her tell you why,” replied Vincent. Sally sipped fresh fruit juice and continued: “So yesterday I met my rival. I was really impressed by her concern and found her a very nice girl.

She did not say in as many words but she is genuinely sorry for what happened, more so how it happened.”

HOME VISIT

A couple of days later, we discharged Sally. She was well enough to go home and also expressed a desire to pass the little time she had in familiar surroundings and with her teenage

twins. Dr Kisia and I visited her at home off and on because we both felt sorry for her, lumbered with a fatal disease at such a young age.

Once when I saw her, she was alone and confided in me. “It sounds strange but Eunice has lifted a weight off my shoulders.

Naturally I was heavily biased against her but it all melted away when she came to see me with Vincent. I was so impressed by her sincerity that I decided to talk to Justin and

Joanna.”

“And what was their reaction?” I asked.

“I told them roughly what you told me and that I wouldn’t be there to look after them for long. Their father and Eunice had promised to take care of them.”

“So, how did they respond?” I repeated my question.

“After the initial outburst of tears, they have accepted reality and have reconciled to the inevitable,” Sally replied. “More important, they have taken to Eunice and their estranged father. To me that is all that matters.”

Dr Kisia and I happened to be there in Sally’s final moments. The twins, Eunice and Vincent were sitting around her bed. “Thank you for everything,” Eunice said to us as we two

doctors decided to leave Sally alone with her nearest and dearest. Just before we left, we overheard Sally say to Eunice: “I am not afraid any more, nor worried. You have eased my

passage. Thanks a million.” She then cast a last lingering look at her precious twins and passed imperceptibly into oblivion, the world of eternal silence.    

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