When Medicine Falls Silent...

This year marks the second birthday I will celebrate without a call from my father. The absence is no longer unfamiliar, but it has not softened. It lingers quiet and constant.

There is a space within me now that was not always there. I struggle to define it. I am not always certain if what I feel is simply missing him, or if it is the awareness that a part of me is no longer intact. Perhaps grief is both presence and absence at once.

In the latter years of his life, we grew apart. Our conversations became less frequent and when they did happen, they were often marked by tension. I have come to wonder if, in growing older, I had begun to resemble him more – thinking like him and responding like him. And perhaps that is why we found ourselves in quiet conflict, more often than connection.

My father passed away in 2024 following what we initially understood to be a short illness. On the 8th of August he suffered a stroke. At presentation, it was described as mild aphasia with left-sided weakness. MRI imaging revealed a small right parietal lobe infarct and a larger infarct in the left parieto-occipital region. He was commenced on thrombolytic therapy with the expectation of thrombus resolution and clinical improvement.

We were reassured. We believed this would be an event he would recover from.
But overnight, his level of consciousness declined. A repeat MRI demonstrated significant extension of the left-sided infarct.

When we arrived at the hospital, the shift was undeniable. The possibility of death which had not once entered our minds, now stood quietly in the room. My father, once strong, animated and certain was now dependent and diminished in a way that felt both sudden and incomprehensible.

The treating doctor met with us and explained that there was no further curative intervention available. After that conversation, his presence became intermittent. Access to him required persistence multiple calls, repeated follow-ups, often initiated by my mother or myself. It began to feel as though he was avoiding not only our questions but the weight of what remained unsaid.

After approximately four weeks, my father was transferred to a rehabilitation facility. There, too, medical visibility decreased. The structure of care continued but clarity did not.

In that period, I found myself asking questions I had never been prepared to confront. When should the transition to palliative care have been initiated? At what point should the goal have shifted from prolonging life to preserving comfort and dignity?

Could we have had more time at home with him in a familiar, gentle space instead of navigating hospital corridors, holding onto incremental updates and waiting for brief interactions with clinicians?

Reflecting on my own medical training, I realise that palliative care was not meaningfully integrated into our education. We were taught to diagnose, to intervene, to treat and to preserve life. We were not taught how to guide patients and families through its end.

Now that I hold both perspectives; that of a doctor and that of a daughter I recognise the complexity of these moments. The discomfort of initiating end-of-life discussions. The implicit sense of failure when curative pathways are exhausted. The tension between clinical responsibility and human vulnerability.

I also recognise the privilege within which we navigated this experience; access to private healthcare, imaging and specialist care. And yet, even within that system, there was a profound absence.

It leads me to question what this experience looks like for those with fewer resources. If palliative care, care that affirms dying as a natural process, that integrates psychological and spiritual support and that should be introduced early in the course of illness is not consistently accessible even in well-resourced settings, then where does that leave the majority?

In the absence of this care families are left in limbo, oscillating between hope and uncertainty, without guidance and closure.

This experience has revealed something to me with clarity I did not previously have.
There is a need, not only for clinical skill but for courage. The courage to have honest and compassionate conversations with patients and their families. To acknowledge when the trajectory of illness has shifted. To create space for understanding, for preparation and for dignity.

Patients and families are more resilient than we often assume. The truth, when delivered with care, does not harm it allows for meaning, for presence, for choice.

From this loss, I have found a direction.

To engage more intentionally in these conversations. To advocate for earlier integration of palliative care. To ensure that care does not become absent when cure is no longer possible.

Because dying is not a failure of medicine.

And no patient, no family, should have to navigate it without guidance, honesty and compassion.