I stopped dead in my tracks when he couldn’t lift his head off the pillow. The smile of greeting was the same but I knew something was very wrong at his inability to raise up to meet me.

For a moment time stopped and I froze. Not now? This was quick. Oh no!

The last thought was for the four medical students I have brought with me, into this man’s house, as part of their training. What on earth was I doing? My plan that they would see a terminally ill patient had not quite factored in that he might be in the final stages of his life. If I had known this, I would never have come, never dragged some teenagers into the final days of my patient’s  life, with quite such a focus on their curriculum. I had wanted them to see a cancer patient at home, not realising that with this visit they would also see an end of life patient. 

And yet, his family had not asked for this visit, there had no been no telephone call to the practice, no request that I visit. 

As I struggled to take in the dilemma, I focused on the surroundings. We were in the living room, and it was very warm. My patient was in his bed, arranged for him by the district nurses, facing end stage cancer. I had known him and his family for seven years and had been saddened by his illness. Always quick with a smile he had made me laugh; a joker, an upbeat character. 

Today he was struggling to breathe, pale, and unable to do more than catch my eye and give me a weak smile, his head not able to lift off his pillow. The emotions that flashed through me swiftly ran the gamut from anger at nobody telling me he was this close to the end of his life, to sadness at the imminent loss of a lovely man, to an overwhelming need to make sure he was as comfortable as he could be.

I sat beside him, the medical students forgotten in my concern for him, and reached for his hand. For a few moments I was utterly lost for words. I was struggling with my own shock and then found myself paddling frantically,  as if under water, my vision misted by the situation, and finally resurfacing, coming up to find a clearer view. My patient, a lovely, positive man, destroyed in front of my eyes at a still comparatively young age. Here he was, in the very last days of his life, asking for nothing, eyes on me, concern in them. 

I felt the tears in my face just as he squeezed my hand.

“It’s all right,” he said. “ Everything’s going to be all right.” And he gave me a smile of such certainty that I believed him and felt comforted by his words. 

I arranged some more medication, and after sitting with him for a little longer, I left, checking how his wife was doing. She too reassured me that everything was going to be all right. They had a priest coming over and they were ready for what was ahead. They knew. They had accepted their lot as I had not yet done for them. And they were telling me it was OK. They were reassuring me. 

Once back at the practice I sat with the medical students, quite young in their education, only second years, keen to ensure the debrief was meaningful to them. I looked at their young faces, and asked the question, what did you think? I think I held my breath because I was not sure what they would say. That they should have been better prepared to visit a man in his last days of life? That I had omitted something fundamental in my shocked state at finding my patient so ill? That I had somehow been guilty of a dereliction of duty in not knowing he was so ill? I braced myself. 

At first there was nothing, just silence. 

Then, tentatively, one ventured: “it was amazing,” and all at once the others joined in. That I could have had the courage to show my feelings in front of my patient, that he had had the strength and the care for me, his GP, to reassure me, to tell me that everything was going to be all right, that was quite incredible. 

“He understood that you cared,” one said, “ he could see that, and in knowing you cared for him, he wanted to care for you.” 

Another wave of emotion for me in their responses. How could they, with so little medical experience, so little life experience, have understood so much, when so little was said? 

So much of our teaching is verbal; we prepare our students for situations, analyse them before, during and after, discuss symptoms, diagnoses, management plans, ad infinitum. And yet here, they had experienced one of the many unplanned, unforeseen encounters that characterise Primary Care. They had seen me lose my usual control of a situation, had seen a patient in charge of the consultation instead of the other way around, had seen the clinician become emotional, and all with less than ten per cent of the usual dialogue we have come to expect from a doctor patient meeting. They had witnessed humanity at its most natural. One person had had a shock, an unexpected realisation and the other, who had had time to come to terms with his mortality took the role of protector. The humanity transcended roles, education, training and societal position. This was simply one person comforting another. One person recognising the humanity in another. 

The learning for the medical students that day was, I hope, career defining. I hope they continue with their lives in medicine knowing that when all is said and done, life, emotion and human connection are  far greater than any medication, any diagnostic test, any record breaking surgery. The power of that patient on that day to teach those students, and me, about life, care and love was unrivalled. 

I will never forget him.