Tag Archives: realist

Happily Ever After: a Disney concept or reality?

I am a huge Disney fan. My late grandmother Mamie introduced Disney to both my sister and I early. Every time she travelled abroad, she would return to Yola bearing delicious large variety boxes of chocolate and Disney Videos. She would watch the animation movies with us and being an adult, she got some of the more subtle humour and would chuckle away to herself. For us, it was about the songs and the princesses, about the girl finding her prince against all odds and getting that happily ever after. My sister and I knew all the songs and when we drew pictures, it was always of the beautiful Disney princesses with their tiny waists, long hair and dainty feet. It is not hard to see why I wholly believed then that every little girl would grow into a beauty, find her soul mate, fall in love and live happily ever after with lots of happy children. To make it worse, I was also an avid reader and there was nothing I loved more than fairy tales, all with their happily-ever-afters and when I became a teenager, I read numerous paperback romances.

Unfortunately for me, reality intruded at some point during adolescence. I was witness to women who had been beaten by their husbands, those who were practically enslaved and could not leave their homes on their husband’s say so and those who were in forced marriages, mostly young girls like me. I went from thinking that every little girl was destined to be happy to believing it was all a fairy tale and that there was no such thing as a happy relationship between a man and a woman. I still believed in romance but I believed that romance didn’t tend to last beyond the ‘honeymoon’ period of a relationship. I also learnt about the widespread deceit being enacted by adults who seemed blissfully happy in their marriages.

I could not find any aunties who could say to me that their marriages were truly happy. Even those who at face-value were living a fairy tale. I found out that many came to be content with their lot having gone through a lot of heartache and choosing to put up with the husband they got as opposed to looking for Mr Right. Most had considered leaving their marriages but on balance thought the security of a marriage outweighed their hurt and betrayal. Many had been cheated on, more than once. A good proportion were the main breadwinners in their household yet were still treated as secondary to their husband. They took the lion share of responsibility, financially and socially. They fed and clothed their children, they made sure the children attended school and did their homework. They sent the children to Quranic School and made sure they learnt to say their prayers and how to fast when the time came. They were the nurturers and disciplinarians. They did it all for little appreciation in many cases.

Unsurprising, I was quite cynical when it came to love. I had very few relationships that lasted longer than a flirtation over a week or maybe one date. Before I met my husband, I had two ‘significant’ boyfriends. I think it is pretty telling that both of those are guys I met on holiday and only gave them a chance because I was on holiday and in the mood to have some fun. The first one lasted about 7 months but the last 2 months wasn’t really a relationship. The second lasted about a year and I really did consider a real relationship with him but I had my rational hat on throughout and I could see how bad he would be as a potential life mate. It was clear to me that we were not in the same place in our lives so I broke it off, difficult though it was.

I was single for 4 years before I met George. By the time I met him, I was happy being single. Loving my space and the freedom to do what I wanted when I wanted, unlike many of my friends. I was happily alone and not at all lonely. The only thing missing in my life was children – I had always been sure that I would one day be a mother. I even had a plan for that. I wanted to take a year out to see the world then come home and work on my career for a few years. Then when I was comfortable, I would find myself a gay bestie who wanted children without the ties of a relationship and we would have a couple of children raised in harmony. Plan B was to go to a sperm bank and find myself some quality swimmers. The only concern I had was explaining to my extended family back in Nigeria who the father of my children was.

Of course, best laid plans and all. I was making plans and God had plans for me. Just before my year of travel, I met George and I was suddenly in a real relationship. George says he knew within a few days he wanted to marry me. It took me a little longer to be sure but I was pretty sure within 3 months that this was the man I would risk getting my heart broken for. We have been together for over 4 years now. We have, like everyone else, had some ups and downs. Some of the best times in my life have been in the past 4 years. Some of my worst too. Some of them because of the relationship, a good proportion nothing to do with personal life but for which I was glad I had George to lean on. I have grown up and learnt a lot about myself. I have found that I have infinite patience I could have sworn I didn’t possess. I am capable of much love despite hardship. I am capable of trusting a man. I still can get really angry but yet my capacity for forgiveness has grown immensely.

Question is: does happily ever after exist? I don’t have an answer. I wish I did. I know there are couples out there who give me hope. My grandmother and grandfather were not a perfect couple. I know Mamie (my grandmother) had to put up with a lot through the years and her patience had to have been great but I also know that Baba (my grandad) loved her and that she knew he did. He never forgot her birthday or their anniversary. He never passed on a chance to show her off. He loves all of his grandchildren lots but he has a special spot for the 3 of us named Aisha, after my grandmother. When she died, it was clear he was lost without her. She died just before their 50th wedding anniversary. He went into deep mourning and we were all worried for the first year after that he would self-destruct. He couldn’t bring himself to mention her name or talk about her for many months. When the raw wound finally began to heal, he would mention her with reverence and such love that it made me well up. Theirs was definitely a till death do us part affair. I cannot attest to how happy they were but I like to think it was happily ever after, at least for Mamie who died secure in her husband’s love.

As a relative newly-wed, of course I want to believe it will be a happily ever after affair. I only agreed to say I do because I had hope that it would be forever. No one goes into a marriage wanting it to fail. However, the facts speak for themselves a bit here. These are from the Marriage Foundation and the Office of National Statistics:

‘The Social Justice Outcomes Framework reports that 45% of children already see their parents separate. Unless trends change dramatically, nearly half of all children born today will not still be living with both natural parents on their sixteenth birthday.’

‘34% of marriages are expected to end in divorce by the 20th wedding anniversary.’

‘There were 241,000 marriages in 2010, near a 100 year low. Cohabitation rose from 2.1 million couples in 2001 to 2.9 million in 2010.’ Maybe because divorce rates are so high, people are opting more and more not to say I do?

There is a lot of good news though:

‘Those who marry have a far greater chance of survival as a couple than those who cohabit. 93% of parents who are still together when their children complete their GCSEs are married.’ In other words, couples that choose to marry as opposed to just living together are much more likely to stay together, have children and watch them grow to the age of 16 or older.

60% of marriages are expected to survive to the 20th anniversary.’ Isn’t that an amazing statistic?

‘16% of marriages reach the 60th wedding anniversary’ and ‘the average marriage is expected to last for 32 years.’ I think those are awesome stats, don’t you?

‘Among natural parents, 31% of those couples who were cohabiting at nine months had separated when the children were seven compared to only 12% of married parents.’ Meaning that married parents are nearly 3 times as likely to stay together for 7 years or more compared to those just living together.

‘Cohabiting couples make up only 19% of parents but account for half of all family breakdown.’ In other words, married couples tend to stay together more than couples who have chosen just to live together.

I will end with this quote:

‘Quite clearly getting married does make a difference to your life chances and your children’s outcomes.’ It has been shown to be socially advantageous. Married people are more likely to be happy than their co-habiting or single or divorced counterparts, despite the shocking divorce statistics. So let us look beyond those stats and go into marriage putting our best foot forward. Sure it is hard work but we all know that anything worth doing is worth doing well. So I remain a realistic optimist. I will work hard at my marriage and I will pray for my happily ever after. I think I deserve it.

The Expiry Date

This morning I read drkategranger’s blog regarding her expiry date (she is a doctor with terminal cancer who talks about death so candidly, it inspires. I would absolutely recommend!!!). The blog and some of the responses to it got me to thinking about death. I have already written about dying and the fact that I fear it not so much. As a Muslim, I tend to see death as just one of those certainties of life so I treat it quite matter-of-factly. This blog is will be further musings about my experiences of death. I will start with a quote from Hadith (Islamic teachings) which summarises how I generally see life and death:

Al-Hasan Al-Basrî said:
‘The life of this world is made up of three days: yesterday has gone with all that was done; tomorrow, you may never reach; but today is for you so do what you should do today.’ Al-Bayhaqî, Al-Zuhd Al-Kabîr p197

I am generally an optimist or more accurately an optimistic realist so I try not to be morbid and I am generally not one to dwell on death. However, I have had times in my life where the thought of dying has crossed my mind. Last winter was a pretty bad time for me. I was working in the hospital that inspired me to become a paediatrician (which still inspires me) but I was in a job with a particularly toxic individual who succeeded in poisoning the atmosphere. I became depressed after 6 weeks of this. So much so that I hated waking up every morning I was scheduled to work. It got to a point that I would lie in bed, sleepless and think ‘would it be that bad if I didn’t wake up in the morning?’ As soon as the thought came to my mind, I would feel guilty and terrible. Guilty because I knew that my life really wasn’t that bad and that there was so much for me to be grateful for. Terrible because I knew my death, although insignificant in the grand scheme of things, would be horrible for my nearest and dearest. My mama especially. I got through those 4 months because my husband was there and would not let me sink into the depths of depression that kept pulling at me. Thank you George!

I am now back to my normal sunny self despite some current work horrors. As a newly-qualified doctor back in 2009, I dealt with death day in, day out especially on my first job on gastroenterology at a busy inner-city hospital. After the initial shock, I got used to it. Not that I didn’t care or it didn’t bother me but I dealt ok with it. There are 2 patient deaths from those days that have stayed with me. Both died of alcoholic liver disease. Both men in their 40s.

The first patient died slowly from hepatorenal syndrome (HRS). Basically with chronic liver failure, if your kidneys too fail, you will die soon because that means 2 of your 4 vital organs are dead or dying, unless you get brand new organs (i.e. transplants). As things currently stand, you cannot be put on the transplant list for a new liver if you are still abusing alcohol because the new liver will get damaged just the same and it is considered a waste of an organ that is in high demand but short in supply. So with my first patient, who I will call Patient A, when his kidney function tests declined rapidly and nothing we could do medically fixed it, we diagnosed HRS and my registrars and consultants had a meeting with his wife to inform her of the diagnosis and what that meant for the patient. He too was told in due time but because of his liver failure, he was confused and did not fully grasp the fact that his condition was terminal.

He deteriorated slowly over a few weeks but in the meantime, he would ask me daily when he could go home and travel to India to be blessed in the Ganges River. I would mutter something non-committal and beat a hasty retreat out of his side room. Initially, it was clear that his wife knew his death was near. But even she began to belief he would miraculously recover from his liver and kidney failure. Every week, she would say something that made us worry we hadn’t prepared her for the inevitable. Every week we would remind her gently that although she couldn’t see it, he was in actual fact deteriorating judging from his biochemistry lab results and worsening oliguria (he was weeing less and less).

In the week of his death, he suddenly looked well again. If I wasn’t the doctor patiently doing bloods on alternate days and chasing those results and noting the relentless rise in his urea and creatinine, I too would have started to believe in miracles. His wife upon seeing the light return to his eyes and his demeanour brighten plunged headlong into denial and joined him in planning their trip to India to the Holy Ganges River. Less than 24 hours before his eventual expiry date, it was devastating for me to watch her grief as the light in his eyes faded rapidly and he shrunk back into himself. Within 12 hours of his final illness beginning, his strength was gone and his mind with it. His utterings became incomprehensible and he became completely disorientated. The look on her face said it all when we came in to see him on our ward round that morning. We returned the look and she ran out of the room to sob in the corner. He was anuric by then (had stopped weeing completely) with a creatinine of over 400 (in other words, his kidneys had packed up). His liver function tests painted an equally damning picture. We completed his end of life paperwork that morning and when we left work that evening, he was hanging on by the tips of his fingers. We came in the next morning to the news that he had died before the end of the day before. The side room he had occupied for many weeks stood empty, awaiting its deep clean before the next customer.

Patient B was a young alcoholic who had developed liver cirrhosis in the months before I started the job. He had just turned 40 and I don’t think had any idea how serious the consequences of regular alcohol binges could be. Reality hit when another patient who was his ‘neighbour’ on our ward developed HRS and died rather quickly. All of our words of warning had somehow not sunk but with this other patient’s death, his mortality was clear to him. He called me over urgently that afternoon and said ‘Doc, I am ready to change’. I was pleased and felt a sense of accomplishment when I referred him to the rehabilitation programme. His wife found me the next day before they were discharged home to thank me for getting through to him. I was honest to say it wasn’t anything I did.

Unfortunately, he came in a few weeks later unwell with an infection which caused his liver function to deteriorate badly. I was encouraged to hear that he had no touched a drop of alcohol since his last admission. He developed litres of fluid in his tummy and I had to put in a tube into the side of his tummy to drain out all that fluid. He was in a lot of discomfort and fearful for his life and he asked me ‘Doc, am I going to die?’ I hesitated over the words I used but in the end I made no promises. Just that I would do everything I could to help him get through this. At first, it looked like the drain and intravenous antibiotics were effectively doing the job and the next day, the fear was gone from his eyes. I was encouraged by his blood results and left having ordered some more routine bloods for the next morning. Coincidentally, at I was securing his abdominal drain, I carelessly dropped the needle I was using to suture and when I went to retrieve it, gave myself a needle-stick injury. I had to get a co-doctor to inform him and take blood samples off him to check that he didn’t have any blood borne infections I could catch. He apologised every day after the event like it was his fault I had stuck myself with a contaminated needle. He asked me about those results daily – he seemed genuinely to care for my welfare. This went on for over 2 weeks as he slowly improved.

I was doing the ward round alone one morning when I was called urgently to his side. He was in a great deal of pain and was writhing in his bed with his abdomen larger than before we drained him. He was pale and clammy and his eyes looked like a man staring down the barrel of a gun. I could barely make sense of his words and as I changed his prescriptions, called the blood bank for blood products and prepared to get a new drain inserted. I could see the life begin to ebb out of his eyes. In a panic, I called my registrars and told them I needed them on the ward ASAP because patient B had taken a turn for worse and nothing I was doing was making a difference. The registrar told me to leave the drain for the meantime and focus on reassuring the patient. After I asked the nurses to call his wife in, I went to him and I held his cold hand. I looked into those eyes and I knew in that instant that he was not long for this world. I remember saying a mental prayer that he could hang on for his wife to be by his side.

‘Doc!’ he cried. I squeezed his hand and responded ‘Yes B?’

‘I am dying aren’t I?’ he asked. I looked down and swallowed the lump in my throat. ‘I am here for you B and I will do everything I can to help you. Your Mrs is on her way in.’

‘Stay with me,’ he entreated fearfully. I nodded and again I had to look away because the fear in his eyes was too powerful for me to take in. The rest of it was a blur. His wife made it in before he died but not in time for him to know she was there. He was delirious by the time she got to the ward and as he was slipping away before our very eyes, there was little time to have ‘that conversation’ with his wife. The consultant whisked her away and broke the news to her. She could see that treatment was futile by then and knew that he was on maximal available medical treatment. We had no more to offer. She signed the DNAR (do not attempt resuscitation) forms and we set about making him less agitated. When we finally called it a day, he was less distressed, still mumbling incoherently and his eyes had started to take on that distant look I now associate with death. I came in the next morning to a request to come to the morgue to complete his death certificate and Crem forms so that his wife could lay him to rest. I got a call 3 days after his death to say his blood tests for blood borne infections had come back negative so I was in the clear. I cried in the staff toilets. He would have been relieved not to have put me at risk I think.

What did patients A and B teach me about death and dying? Firstly that when it is your time to go, it is your time to go. Life unfortunately doesn’t usually give you a clearly labelled package with an expiry date on it. Secondly, although death is scary for the person dying, it is actually worse for the person who loves them who has to watch them lose their battle to live and battle their fear of the unknown. Who has to go home and face life without them and rebuild their lives around the hole left by the dead loved one. Who for a very long time will think about their dear departed every morning when they wake up and every night before they fall asleep. Lastly, every human is unique. Despite having the same disease and modifying your risk factors, your body will do its own thing. We doctors can try to influence outcome but whether we succeed or not is not within our power to control. That is beyond science and medicine. That is life. That is God. That is reality. May we all depart this world in the easiest swiftest way possible. Amen