I need it for various things: changing bills into my stepmother’s name, remembering the actual date he died (I know it seems ridiculous but I can’t remember) for a ‘fuck you’ health complaint, for the lawyer…etc.
I note that the primary cause of death is metastatic renal cell cancer, with the contributory cause being a three years prior head and neck malignant melanoma. I nod, pleased in a vague sort of way.
One of the things that distressed me about my father’s illness was that his third operation took out secondary tumours but they didn’t find (or look for) or even identify the primary tumour. I always thought it was the skin cancer on his face but he was too ill after the colostomy for them to want to give him more tests to find the primary. Both he and my stepmother never actively sought for a complete diagnosis, accurate labelling or even a realistic time span (or such was our impression), and we, as their support team, didn’t feel that we could push the issue, given that they were dealing with it in their own way. It wasn’t until I got myself registered as equal next of kin that the doctors would even discuss his health with me but, prior to that, it was immensely frustrating not to know.
So, to see the diagnosis that I had always thought written on the death certificate was very reassuring for me. It was a confirmation that my instincts and practicalities were right and my way of handling it, both time frame wise and medical decision wise, were right.
(I think I’ve mentioned this before but once I got really involved in my father’s care, my stepmother left all the medical decisions to me as it was so hard on her just handling the day to day stuff. I wrote a letter, purporting to come from my father, authorising me as a caregiver and a person with the right to know. Then I told him what I had written and asked him to sign it for me, which he did.)
The annoying inner me, who likes labels and clock countdowns and worked out plans of action, felt satisfied with the neat confirmation of the final unknowns in the equation.
For a very short while.
Then it occurred to me that perhaps the death certificate wasn’t written to conform to my views but rather as a result of my views, and my world tilted horribly.
You see, I did most of the medical interaction with doctors and nurses and for decision making in the last few weeks. When my father came home to die, he was discharged from the hospital into the care of the Silver Chain support network and part of the home discharge included an initial interview with a Silver Chain doctor.
He was discharged on the Thursday and the earliest appointment for the initial interview was the Friday afternoon. The whole ambulance fiasco happened on the Thursday and caused such pain and shock that I honestly thought he might die that night. I phoned up the 24 hour Silver Chain network and begged for more pain relief and told them that I thought he was in the last stages, even though he hadn’t followed proper procedure and had the interview first so that they could change the level of pain relief. They said that they would have somebody call back in about an hour to see if I had managed to get his pain under control. They didn’t and I had. For about four hours only.
The next morning, after numerous phone calls, I managed to get a nurse out there to help him. It took literally hours as she was with another patient first and then the traffic was bad and then the shift changed. Finally, she arrived and bumped up his pain medication levels and he fell into a deep sleep/low level of unconsciousness.
Which is where he was still at when the Silver Chain nurse arrived to do the intital processing. I must say that neither my stepmother or myself like this (male) nurse. He didn’t offer any words of sympathy, made no effort to engage with my father and took an incredibly long time to complete the process, all the while complaining that new intakes took up so much time and he wanted to finish early as he was going on holiday to Thailand the next day. And he used our bathroom twice, for incredibly long periods of time. I am a bad person to say that the image of him buggering small boys in Thailand immediately jumped to mind but it did: both to me and my stepmother. Yes, hate away. I know that I am awful but he was awful to us.
After he had changed the spinal morphine pump pack dosages the pain levels were controlled for the moment. Dad fell deep asleep.
When the doctor came in, she wanted a full medical history, which I gave her. But it was my suppositions. The kidney cancer was real, as was the initial melanoma, but I didn’t know if they were linked – I just thought they were, which is what I said.
So maybe that death certificate reads the way it does because of me and that is awful. Awful because I am not a medical professional; awful because I hate to think of true professionals taking note of my word; awful because they should have diagnosed it themselves and I feel they have failed us.
I don’t know if the wording on the certificate is a true summation of events or not and it distresses me because my father was always such a truthful man. Another way I have failed him.