Filler

A lie softly spoken

She was a vivid patchwork of red and black from ankles to neck, surrounded by a miasma of singed hair and charred flesh. Even from the end of the trolley, the story and outcome were obviousa cooker fire, a burning nightgown, dripping molten rivulets down her legs and pooling on her feet. She'd been lying for several hours before discovery, and, although conscious on admission to casualty, she was clearly moribund.

Awoken from a deep sleep, I performed on autopilot: wide bore intravenous lines, fluids, intubationall textbook ATLS stuff. A secondary survey confirmed our first glance impression. The decision was straightforward (she had no relatives, was elderly, and with more than 70% burns): admit to intensive care, keep comfortable, and allow her to die. Filled with opiate, she died several hours later.

My most meaningful contribution to her care had been to talk softly to her as I prepared to anaesthetise her: "Think of something nice to dream about, we're just going to drift you off to sleep and get you sorted out. You're going to be all right." The lie slipped out easily, effortlessly lubricated by frequent repetition over the years.

Two showers and 24 hours later, I still fancied that I carried the aura of charred flesh with meshopping, to my sons' nursery school, around my own home. I struggled to imagine her last few awful, pain filled hours, helplessly waiting for discovery. Immolation is far down the list of good ways to die. Can any of us foresee our own ends, do more than hope and dream for a quiet death in our own beds?

So why write this?

Even in the face of imminent death, maybe especially then, human contact and hand holding are of more value than simple technical skills.

Also, I lied to her, and would do so again in similar circumstances. Should I? Would you? Can lying to patients sometimes be the right thing to do? Or does this story illustrate a lingering paternalism and arrogance that doctors may have when dealing with patients? I have no easy answers to those questions, and suspect there aren't any.

Ian Nesbitt, consultant in anaesthesia and intensive care. 

Newcastle upon Tyne