“Dear Grandma”

by Dr. Patricia Lyle

Dear Grandma,

I look at you with tear-filled eyes, not as the physician I have been trained to be, but as the granddaughter who grew up listening to your stories of the old days, of pesky kids and army pals. I watch you fade in and out of sleep, watch each breath you take and wonder. I count the breaths; watch the rate, considering how many you may have left. Thoughts of medical assessments running through my mind, glimpses of the career path I have chosen, mix with thoughts of the past, thoughts of you, who you were and are still.

These medical thoughts fleet in and out, like your consciousness. Is she orientated? Should I check? Do I want to know? Does she really know who I am or just another face that comes to visit these long days filled mostly with sleep. I reach for your hand and feel the warmth, the strength in your grasp, I start to rate it on a scale, how does it compare to the other side, is there a difference? I stop. Why? These thoughts of who I am to my patients, cloud my thoughts of who I am to you. I am still the same little girl who snuck Werther’s candies from your purse and looked forward to your Christmas letters every year. Only you could ever put my Dad in his place, and expose him for the mischievous rascal child he was.

Now you lay there, so helpless as I lift the spoon. I think of the risks of feeding, the risk of you choking and the following risk of pneumonia if food went down the wrong way. I stop myself. I remember how strong your appetite always was, especially for sweets, and I realize the benefits far exceed any risk for you. To be able to enjoy what little you can still. I see you wince in pain. I ask but you can’t tell me where it is. The frustration I feel at not being able to treat you like I have others. To cure your pain and find the cause. “Her pain is not controlled,” I tell the nurse. “She is having breakthrough pain; can we change her medication from Q 6hours to Q 4hours?” Slips like this expose me for who I am now.

So many questions I have but each time I ask, doctors answer as a colleague. “Does it matter where the pain is? Consider her age, her clinical features, her comorbidities. Life expectancy and treatment do not justify further investigations.” I understand this terminology, but she’s my grandmother, shouldn’t it be different? I want to know. How long does she have? How fast will the tumor grow? What type is it? Where is it? What is her prognosis? Will she go to long term care or hospice? “She’s 94, she’s lived a good long life,” the doctor replies. Yes but that doesn’t change the fact that she is my Grandma.

I play physician every other day but today, I am here for her. I am her granddaughter and I love her.