TO SPEAK | Krishna Chaganti
“How does it happen?”
She had her hand on the doorknob, had already stood up to go. The other was on the grip of the portable oxygen tank she dragged behind her.
“Do I just suffocate?”
I hesitated. I didn’t know what to say.
“Don’t worry,” I said—a lie.
She nodded and paused, then opened the door.
“I love you, Doctor.”
I looked down, embarrassed. I should have stepped forward, embraced her. Said something. I might have, had this exchange happened now, after I have seen death from close. But I was still growing into myself then.
I could have told her — would she have wanted to know? — the way the breath would be labored, long pauses in between that would frighten her loved ones into not leaving the room. How, maybe if she were lucky, no one would even notice at first when she stopped breathing, it would be that peaceful. The inhalation would cease, the effort too much.
I could have told her the physiology of the end. How her breath traveled down the lung passageways towards those smallest surfaces of blood and tissue that await. How, in her case, that essential exchange of oxygen couldn’t happen because her alveolar sacs were thickened from inflammation and scar. Her breath cycle a promise, broken.
I could tell her that hearing is the last sense to go, we think, so words from those close by would still matter. Phonation, so fickle for her, could still be used by others to shape small consolations. Words that might help at the end.
When she died a few weeks later, everyday demands at first outpaced my sense of the loss: I notified clinic staff to cancel her appointment reminders, messaged her other healthcare providers, wrote a letter to the safari company on behalf of her husband so he could get a refund for the trip he had planned.
And I knew my feelings about her death were not just sadness. In those moments in the clinic, the words I did not say were the unnavigated depth between us. Like her body, I too had failed her, both in the most crucial way of not treating her illness effectively — though we had done our utmost — but also in not being able to soothe and support her for what she was to face next. And in the end wasn’t that the role of the healer too? It was instead she who had extended the comfort of words to me in our last meeting, forgiving me my inadequacies.
I write as an apology to her, for what I did not do or say. I had not learned in all my years of training anything to prepare me differently. It took time for me to learn how to speak about essential things.
Krishna Chaganti is an associate professor of rheumatology at AUCSF Medical Center. Chaganti has been writing short creative essays for several years as a way of understanding her interactions with patients and examining things that happen in her non-medical life too.