1917.
A mother prematurely gives birth to triplets. Two babies are strong and healthy. The third is weak, barely breathing. No cry.
The midwife wraps her in cotton woll and places her in a shoebox by the fire.
Her mother nicknames her Tiny.
She survives.
Several years later she falls ill with rheumatic fever. She is in hospital for many many months. No one expects her to live.
She survives.
Years later, she meets a man.
She wants to have children, but has been told she will never conceive.
She bears two children.
Strong, healthy.
She raises them.
At age 90, her husband dies.
She has multiple health problems.
She cannot remember her children’s names.
She does not recognise them.
She enters the nursing home, and quickly becomes everyone’s favourite.
She is frail.
Noone expects her to live for long.
She survives.
At age 100, she falls ill.
Her children gather round her.
They say their last goodbyes.
Noone expects her to live.
She survives.
I meet her in October 2019, when she is 102, on a day when she has been lethargic, is not eating or drinking, and is having trouble talking.
I prepare her family for death, and chart injectible medicines.
I think she might not live more than a week or two.
She survives.
December 2019.
Three weeks before her 103rd birthday.
She sits in a chair in the dining room.
Someone notices she does not look well.
They try to speak with her, but she does not respond.
They gently get her back into bed, and ask me to come and see her.
Shallow breathing, barely detectable.
Weak peripheral pulse.
Bradycardia.
Grimacing.
Agitation.
A stroke, I think.
Another discussion with her children.
They are shaken, but pragmatic.
“She wasn’t supposed to live”, her son says.
Yet they wonder if she will pull through again.
She has surpised them many times before.
She is a survivor.
We start a syringe driver, a gentle infusion to keep her comfortable.
She is so tiny and frail, that I hesitate with the doses.
I err on the side of caution.
5mg midazolam, 1mg hydromorphone, over 24 hours.
Tiny doses for a tiny woman.
24 hours later she is not comfortable.
She has needed several breakthrough medicines.
I recalculate, and increase the dose.
I promise to return the next morning.
When I arrive, I see the paperwork on the desk.
The GP has left minutes ago.
The staff are preparing for a guard of honour.
Everyone is bereft.
She was the invincible one. The survivior.
Noone can believe she is finally gone.
We stand in two lines, and solomnly watch her leave
the same way she entered, through the front doors.
I stop and shed a few tears for this tiny person
who was larger than life
and so much stronger than everyone gave her credit for.
I have work to do, and need to move on to the next patient.
I hesitate for a moment.
I think to myself that I will never look at cotton wool in the same way again.