I cried in the car today. I fixed my mascara in the rear-view mirror before afternoon surgery, so I'm almost sure I got away with it.
When I arrived at the nursing home, the paramedics were wearily checking their kit in the back of the van. Rain dripped down the back of my neck as I leaned in to thank them for trying.
Her room was stuffy, lingering sweat and panic in the air. Hastily discarded plastic wrapping, defibrillator pads and bag and mask surrounded her on the floor. Someone had sliced the front of her T-shirt raggedly, leaving her chest exposed, waxy and pale. Her nails were painted bright pink.
Fiona, a kind senior nurse I knew well, held back tears as she told the story. She had been having lunch, helped by a carer. Her neurological condition had stolen away most of her swallow, but she still loved the childhood comfort of sweet puddings and ice cream.
Suddenly, quietly, her heart had forgotten to take a next beat, and not even those expert life-savers in green jumpsuits had been able to convince it to start again.
When her heart stopped, two spoonfuls of custard into her lunch, the staff phoned 999Dr Meeten
It was a far quicker end than we would have predicted. A monstrous disease, hidden in her genetic code, had been eating away at her for years. Bite after cruel bite.
The first signs were the jerks and twists of her limbs, making it impossible to hold a cup of tea. The genetic clinic dealt the blow, and relentlessly the illness took her job, voice, sanity and finally, her overwhelmed family. Now home was this room, nurses and daytime TV for company and some framed photos to remind her of what was lost.
We had spent a difficult morning together, trying to understand her ideas about the future. What should we do when her swallow stopped working? Would she want us to form a tube into her stomach for liquid feed? If her heart stopped suddenly, should we try and revive her? How tight was her grip on what was left of her devastated life?
Not easy questions for anyone, never mind someone whose vocabulary had shrunk to a handful of mumbled words. I hope we did our best. I hope I gave her the dignity and time she deserved.
Her choices (no tube feeding, but yes please to CPR) had been noted in all the right paperwork and so when her heart stopped, two spoonfuls of custard into her lunch, the staff phoned 999.
I performed my ritual checking for signs of life, stethoscope on her silent chest. It was a strangely holy moment. She lay, still and grey as a carved queen on a tomb, finally resting after years of incessant movement. The nurse and I were quiet pilgrims on our knees beside her, as though in silent prayer. I felt strangely reluctant to leave her side.
The tears started as soon as I left the carpark.
Pulling into a layby under some tall pines, I closed my eyes and rested my forehead on the coolness of the steering wheel. She wasn’t my first sudden death, not even the first death I had certified that week. Why was this one hitting so hard?
She had been less than five years older than me. Too young. The children in those framed photos were only a little older than mine, and who could blame them for finding visiting days too sad to endure?
Perhaps that proximity drove home the monstrous unfairness of a life so destroyed by a tiny faulty gene. Perhaps it was the heartbreaking silence of her wasted body on that floor.
I wiped mascara from cheeks and chin with my sleeveDr Meeten
Perhaps the teaspoon still resting against the rim of the abandoned bowl of custard on her table.
Rain continued streaming over the windscreen, as steadily as the tears on my cheeks. The beat and whoosh of wipers and tick of hazard warning lights kept time, reminding me that my afternoon was far from over.
Turning the key in the ignition, I wiped mascara from cheeks and chin with my sleeve, and pointed the car back towards the health centre.
I gave myself three minutes in the car park to let my red eyes settle, then straightening my shoulders, headed through the waiting room with a watery smile for its irritable occupants. I thought I had pulled it off but as I closed my office door I heard a loudly stage-whispered complaint.
‘She's always bloody running late, that one!’
Gyda Meeten is a GP in Clackmannanshire. Her winning entry to this year’s BMA writing competition can be seen here