platform ticket …

Derek Doyle in his book The Platform Ticket

Perhaps it is only when you have worked in a hospice that you truly appreciate … that it is not death which people fear but the manner of dying, whether it be the pain or the fear or, we are often told, the loneliness. Let me tell you a story which has become one of my favorites, a delightful story about a lovely old lady. It begins with me sitting beside her shortly after she had been admitted from her beautiful little apartment where we had cared for her for a few weeks. Now too frail to remain there alone but very comfortable and without any of the pain and anguish she had had when first we met, she was now settling in to her new and final home. I asked her how I as her new doctor, could help her, knowing as I did that she was not likely to have much physical suffering. Her answer took me by surprise.

“Young Man, She said, making me realize that her eyesight must also be failing fast, ‘I have mixed feelings about what lies ahead. If you can spare me a few minutes let me try to explain what I mean.

‘A bit of me is excited, in fact very excited, just as you feel when you’ve seen a holiday place advertised in one of those glossy brochures but never been there and, more to the point, never ever met anyone who has. It’s also a curious feeling when you’ve only got a single and not a return ticket because you know for certainty you’re not coming back! The other thing I have to tell you is that I’ve had my bag packed for a very long time. Now that’s a curious feeling too. It’s a little bit like British Rail. You know the train will come but when another matter altogether! You know it’s no use asking anyone because no-one knows any better than you do! When you get to my age all these things add up to a very new experience, as I’m sure you understand. I’m one of those people who prefers the familiar to the new and untested, and I suspect I’m not unique in that.

‘However, that is no the biggest trail I am facing, waiting for my train. Believe me, waiting on this platform is a very, very lonely experience even when the brochure said it was a nice place I’m going to, even when you have a ticket and even when you’ve been ready for the journey for a long time.

‘You very kindly asked in what way you could help me. Well, let me explain so that you will understand. I am finding this the loneliest time in my life. I’m surrounded by nice people and everyone is so kind, but I’m still lonely and just a little frightened because’ (and here she gave a timid laugh) ‘I’ve never done this before, you must remember. Until that train comes in… Well, I would love you to stand beside me. For that you’ll need to purchase a platform ticket! Now do you understand? No, perhaps you don’t because you are too young.’ (She was not the sort of lady who would try to flatter her doctor so I was now sure her eyesight was gravely impaired.)

‘When I was young they only allowed you to go on to a platform if you had a ticket for the train or if you had a platform ticket so that you could wait with your loved on or friend. They only cost a penny, in the old money of course, but what a joy it was to stand together a little longer at such little cost. I suspect we all like someone with us when we go off on a long journey, don’t you think? I see you understand now.’

Each day when I went to see her she just shook her head and told me I was not needed. Days and days went by. Then one day, when she looked no different to me, she whispered ‘Have you got your platform ticket?’ I reassured her that I had and carried it with me wherever I went. She invited me to come and sit beside her, which I did.

‘Oh what a curious feeling to be so lonely and at the same time so excited’ she explained. ‘We don’t need to talk, you know, but I need to know that as that train comes in you’ll stay beside me until I tell you. That’s the point when I shall have to leave go of your hand and take that last step on my own. I know I’ll manage if you are near me.’

It is difficult to describe atmosphere and ambience. Sitting with that lady was to experience a peace that is so rare in life. I think other doctors would agree with me that we are trained to talk but now how to remain silent. We are taught how to explain but not how to listen. We are taught how to be energetic but never how to restore peace and tranquility by our inactivity. We are taught nothing of inner peace, nor of loneliness, and nothing whatsoever of the power of love and undemanding companionship. Those minutes which followed were some of life’s richest for me.

What privileges we enjoy in our in our profession. My Musings were abruptly cut short.

‘At last!’ She turned to me and smiled. Her thin hand squeezed mine as she whispered ‘Sometimes we need doctors and sometimes we need friends. It’s best of all when our doctors are also our friends. Thank you, dear, for being my friend. You cannot come any further but don’t worry. I can manage now.’

Her grip loosened. I turned and looked at her. She had never moved. On her thin, lined face there was a hint of a smile. She was dead.

I sat for a few minutes pondering on what had just happened. I thought back to the years I had spent training as a physician, striving to understand and practice modern scientific medicine, taught and inspired by brilliant men whose shoes I would never be able to fill. Understandably they had never mentioned platform tickets but neither had they alluded to the many other skills I now found I needed, ministering to the dying. I had been taught how to teach and how to speak, not how to listen and how to hear what was really being said in myriad ways.

I had been told about anxiety and the distress it can cause but given no insights into the crushing power of terror. Never had I appreciated that loneliness, rather than aloneness, was like a cancer which seemed to suffocate. No one had told me that love can at one time be healing, and at another be dangerous and damaging unless it is totally self-denying.

I looked around me at a world with which I thought I was very familiar and where I felt at home, the inside of a hospice, looking in most respects little different from any small, homely hospital. Familiar and safe to me, but what does it feel like to a person who knows it is their life’s departure lounge? What makes a place safe for on and frightening to another? I registered that as a question to be answered, as something highlighted by the hospice but probably relevant wherever we care for the ill and frail.

I realized I would have to give much more thought not only to platform tickets but to the whole of that journey so many of our patients were taking. What was it our patients really wanted of us, their doctors and nurses? Were my scientific and diagnostic skills to count for nothing? Do patients need something we have not got to give them?

One day I too would be waiting for my train, presumably like my patients, fully aware of all that happening no matter how well my friends had protected me, but would I be ready for it and, I was anxious to know, would there be people there with their platform ticket? Perhaps that was up to me, I thought. As someone brought up in the Christian church my mind went back to the story of Jesus in the Garden of Olives the night before His execution. What He had most wanted and hoped for, but did not get, was for His disciples to stay awake and keep Him company on what must have been the loneliest night of His life.

I suspect much of this book will, in one way or another, be about platform tickets.