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BMJ. 2002 January 19; 324(7330): 152.
PMCID: PMC1122072
A memorable patient
Beware ill relatives who request second opinions
David Fisher, former general physician
Cardiff
 
Against my better judgment, I was persuaded by two of my wife's elderly spinster aunts to examine their sister, another spinster. “She's just not right,” I was told by telephone. She arrived the following morning after a car journey of some 150 miles, and they had been correct—she was not right, she was in left heart failure. Subsequent examination in hospital also revealed that she had advanced syringomyelia and cancer of the breast, with widespread deposits. She died peacefully six days later. After passing on the sad news to the aunts, I was somewhat tartly told that she had willed her body to medical science, and would I kindly deal with it.

Ella, for that was her name, proved difficult to deal with. Getting the correct forms signed and witnessed by her next of kin involved two long car journeys to her home town, and then the local medical school with which she had registered her bequest informed me that they were no longer interested, since the body was outside their catchment area.

Fortunately, my own medical school was more accommodating. Sighs of relief were a little premature, however, because two weeks later my eldest daughter, a student physiotherapist at the same institution, calmly announced that she was soon going to start anatomical dissection. For once, I kept very quiet.

The months went by, and we forgot about Ella. Almost two years to the day, the telephone rang. The medical school had finished with Ella and said that, yes, it was usual to cremate. In the meantime, both of the other sisters had died, and so, on a lovely spring morning, only my wife, my student daughter, and I gathered to pay our last respects. A youthful vicar arrived, obviously unbriefed, and immediately sought to console us on our recent bereavement, whereupon my irreverent daughter remarked that on the contrary, we were happy that it was all nearly over. I had to take the vicar to one side to explain the circumstances; he, in turn, confided that this was his first cremation.

At first, all went well; the four of us sat in a cosy circle, accompanied by the inhouse organist, who had a nasty cough that merited investigation. All went well, that is, until we reached the point when Ella's body and soul were commended to God (for the first of many times during the service). My daughter started to giggle, rightly pointing out that, presumably, Ella's soul had made the journey two years earlier. After a moment of quiet reflection, the young vicar agreed, and, from then on, he manfully tried to ad lib his way through the rest of the service, sending only the body on that day, since the soul had probably arrived two years previously. Nevertheless, despite his best intentions, on at least two occasions, the vicar sent the soul without the body and, on another occasion, neglected to send either. The cremation service was not designed for those who leave their bodies to medical science, and Ella would have loved it—she always had a great sense of humour.

The end of the service came none to soon for the young man, and he left us with a dazed look in his eyes. Funnily enough, I recognised that look, for I had often seen it over the years on the faces of preregistration house officers at the end of their first day's work on the wards.

Footnotes
We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.