Hektoen International

A Journal of Medical Humanities

When children die

Susan Woldenberg Butler
Canberra, Australia


Publication Acknowledgement: This fictional short story was published in Secrets from the Black Bag (Royal College of General Practitioners Publications; London, December, 2005). 

Angus Easton died surrounded by loved ones who had done everything possible to ease his suffering. Angus was obviously the apple of his family’s eye, and no wonder. He was a terrific bloke. I brought him into the world shortly after I started here and very sadly saw him out not long ago. One of my first home visits had been to his grandfather, an elderly farmer dying of chronic obstructive lung disease. Trouble with the breathing apparatus is a terrible way to die. His lungs were gradually packing it in. His family was around him all the time. Every visit I made, somebody from the family would be sitting beside him. I learned then about the marvels of extended families in rural settings.

Angus was sixteen years old, with everything to live for. One Saturday afternoon, a teammate kicked him during a football game at their school. He fell down. Luckily, the school doctor was in the audience with his son. “He’s taking a long time to get up,” the man said to his son. “He’s obviously not okay. I’d better have a good look at him.” So the doctor pulled Angus off the field and ordered a CAT scan of his head. Very good move. Very bad news. Angus came home after that.

As Angus’ family doctor, I had to perform a duty I dreaded, one that has never gotten any easier. Poor Angus was too ill to come in to surgery. No way would I give him the news over the phone. His parents were willing to come in for the diagnosis, but I felt that Angus should hear it first, alone. As I headed down the avenue of hundred-year-old elms lining the drive to the farmhouse, I thought about how unfair life is, to do such a dreadful thing to such a nice boy. I usually enjoy this drive and had a particular liking for the Eastons’ Georgian homestead, perhaps because of my fondness for the family. As I rolled to a stop that day, I did not feel the usual leap of gladness in my heart as Matey, Angus’ affectionate Gross Munsterlander, bounded to my side. The Eastons had bought this German hunting dog from a neighbor who was moving to the city. They knew he was good with children and hoped he would make a good guard dog, but he never barked at strangers. The raucous peacocks scuttering across the graveled circular drive performed that function better. Matey never minded being out-performed, and in fact got on quite well with the birds.

I could not postpone it any longer; so I got out of the car. Mrs. Easton came running out to meet me. “Oh doctor,” she said anxiously, “We’re so glad you’ve come.”

I tried to smile, unsuccessfully. She knew. We did not need to exchange words. Those were for Angus.

“We’re all gathered ’round Angus, waiting for you,” she said weakly, her voice quavering. “May I get you a cup of tea?”

“I don’t want to trouble you, Mrs. Easton,” I said humbly.

I can’t think why some doctors are arrogant. My patients always humble me with their courage.

“No trouble, doctor,” she said, rallying a bit in her role as hostess. “We’re all having something—although I do wish the girls wouldn’t drink so much cola; it’s so bad for their teeth,” she continued. I let her chatter. As she led me into the house she added, “Angus asked me to make your favorite cheese scones. They’re just ready to bring up.”

“I know,” I replied, swallowing hard, “I can smell them.” I didn’t want to tell her that they set my tummy rumbling, because it shamed me to think that I could respond to food at a time like this.

“You know where he is,” Mrs. Easton said. “Go on up to his room, and I’ll join you shortly.”

The poor woman needed time to compose herself or perhaps delay the inevitable; so I didn’t offer to carry anything upstairs. I trudged up the stairs, rounded the corner and walked down the hall. I could hear muted laughter. “I’ll soon fix that,” I thought grimly, opening the third door on the left.

Angus lay in bed with his two younger sisters on either side, holding his hands. Jane had just turned thirteen. Juliet was fourteen. Mr. Easton paced at the foot of the bed, trying to hide the emotions conflicting his heart. The daughters were genuinely happy to be tending their brother, in that sublime way of children. I reflected for the thousandth time, how different boys’ rooms smell from those of girls. Angus would not be needing the soccer ball or cricket bat spilling out of the closet.

“Thank you for coming all this way to see us, doctor,” Mr. Easton said warmly, coming to greet me with his hand extended. “We appreciate it.”

“Not at all,” I said. “Angus, how are you feeling?”

“I’ve been better, doctor,” he said quietly. He wasn’t wrong. His blue eyes clouded with pain, but Angus didn’t complain. It wasn’t in his nature.

Mrs. Easton entered bearing a tray of tea, cola, scones and sweet biscuits. Her husband went to help her. He placed the laden tray on the desk, on top of some important-looking school papers. No one noticed. After Mrs. Easton served drinks and food, everyone got into position to hear my news. Making sure that people seat themselves appropriately and comfortably is a necessary ritual, I find.

“Angus, are you certain that you would not prefer to be alone to hear what I’ve got to say to you?” I asked, wishing I had better news.

Angus shook his head bravely. Poor lad.

“We’re a close family, doctor,” Mrs. Easton explained needlessly. I could see that in their body language, Mr. Easton’s hand on his wife’s shoulder, she stroking her son’s head, the sisters still holding their brother’s hands.

I blew on my tea to cool it and bit into a cheesy scone, which didn’t taste as good as I expected.

“Angus,” I began. “I want to be completely honest. You have a tumor of the pineal gland, which is right in the centre of the brain.”

Dead silence ensued.

“What’s the prognosis?” Mr. Easton asked gruffly.

“Not at all good, I’m afraid,” I said reluctantly.

“You mean I won’t be taking over the farm from Dad?” he asked, only half-joking.

I put the scone on the blue willow-patterned plate. I had no right to eat it. “You won’t be here next year at this time,” I said gently. I couldn’t bring myself to say that he wouldn’t make Christmas.

I didn’t turn in the direction of the stifled sob from his father.

“That knock on the head—” Mrs. Easton began.

“—Caused a hemorrhage,” I finished.

“He’s always been healthy. We’d have noticed,” cried the distraught elder sister.

“You could very well be wrong,” Mr. Easton said. I know he didn’t intend the remark to sound so rude.

“Please feel free to request a second opinion. I don’t mind in the least. In fact, I sincerely hope I’m proven wrong,” I said, and meant it.

Angus had not said a word.

“I’m sorry, Angus,” I said.

“Thank you, Dr. Grimely,” he said softly.

I’ll never forget the look of incredible relief on that face.

“Don’t hesitate to ring me at any hour, Angus,” I said, preparing to leave the family alone.

Pulling away from the house, I grieved that Angus would not see another cycle of those glorious elms. His relieved expression appeared before me. Terminally ill people prefer honesty. If they do not, they are usually in denial—something that most certainly did not apply to Angus.

I saw quite a lot of the poor child for the rest of his short life. We got him all sorts of radiotherapy, which did absolutely no good and made him lose his beautiful silky blond hair.

One day I went out to the farm. Angus had lost his sight. His younger sister sat on the bed, one leg up and the other on the edge of a chair. She stroked his face while he talked on the telephone. The room was fairly large, conveniently, as it would soon accommodate the various paraphernalia required to keep Angus at home until the end. A signed photograph of a rugby star had pride of place on the dresser. Into a corner of the frame, his father had thrust a small photograph of a healthy Angus playing rugby.

“No sir, pine is fine,” Angus said into the telephone. “I don’t want a lot of money spent on it.” His sister whispered something in his ear. “Please ring me back tomorrow,” he said. “The doctor’s just arrived.”

“How are you feeling today, Angus?” I asked as he replaced the receiver.

“Well, doctor,” he replied with a tired smile, “It’s obvious I’m going to die. I’ve been arranging my funeral.”

The girl whimpered.

Angus groped for his sister’s hand. She grasped it immediately and held it to her face, biting back tears.

I could not do much but prescribe medication for the pain. “Angus, I’ll call in and see you in a few days. Ring me before that if you need anything, anything at all,” I said.

Angus nodded silently and closed his eyes.

As I left, I looked back at brother and sister, so filled with loved for each other, and swallowed hard.

Angus deteriorated rapidly. Every time I went out, one of his sisters was sitting with him. They never left him alone. Mrs. Easton was just great. Mr. Easton was out all day with his sheep, but he and his wife took turns staying up with Angus at night. Seeing the system work well is inspiring, when everything falls into place and everyone works together, even though the outcome is awful. Angus’ mother fed him through tubes, which my partner and I had to take out and put back again, two or three times a day. One of the local oncologists supplied everything we needed. The district nurses were just wonderful. Angus stayed at home rather than going to the hospital, because that’s what the family wanted. The Easton family lived quite a way out of town. They would have found it extremely difficult to tend both house and farm and care for Angus as they wanted.

Over a period of six months, Angus became deaf and wasted away. The family was not terror-stricken, as sometimes happens, nor did they try to exclude Angus because they themselves could not handle it. I was privileged to see that family at its most magnificent.

Angus was one of my saddest and yet one of my most uplifting cases. I was just so impressed with the whole family. Every time I hear my colleagues debate the merits of telling the truth to terminally ill patients, I think of Angus Easton’s look of incredible relief when I gave him the worst news a doctor could possibly give a patient. Every time I eat cheese scones, I think of brave Angus and his admirable family.



SUSAN WOLDENBERG BUTLER was born in Lafayette, Louisiana. She has published fiction and non-fiction in the U.S., U.K. and Australia, including Secrets from the Black Bag (Royal College of General Practitioners Publications) which is on the recommended reading lists of the Association of Course Organizers in the U.K. and General Practice Training in Tasmania. She currently lives with her husband, Colin, in Tasmania and Canberra, Australia. In 1989, Colin and Susan founded Benevolent Organization for Development, Health & Insight (BODHI) (www.bodhi.net.au), a non-profit organization that works in developing countries. For more information about Susan, visit her website: www.susanbutler.com.au.


Highlighted in Frontispiece Fall 2010 – Volume 2, Issue 3

Fall 2010  |  Sections  |  Fiction

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