The Afternoon Before Christmas 2009


I wrote this piece on Christmas Eve, the day I met this patient. It is consoling to read again every year, as Christmas can be lonely as an immigrant to New Zealand.


The Afternoon Before Christmas 2009

Christmas Eve on the surgical ward. One more referral seems a bit too much for me.

She was ninety eight. Being admitted to hospital at 98 years – why?

She is from Turkey with an irreducible hernia. They tried to manually relieve it using fentanyl and midazolam intravenously. She sits sideways across the bed, her swollen limbs dangling over the edge. Her curved body is propped up by many pillows, her white cotton scarf knotted turban-like at the front on her forehead. She is dozing. Her daughter Nareema translated in a beautiful accent as I asked in plain English about her pain and nausea; so plain a language in comparison.

Another daughter arrived in a rush of brown colour and tension. I greeted her and the tall young man ahead of her.

“You need not greet him, my son is autistic, he will get upset.” She rubbed the tall man’s back kindly and constantly as he looked away, his thumb in his mouth …

I tried to explain palliative care to both daughters this time. “The surgeons think operating would be unwise.”

“Too old you mean, her age, of course …”

“No I’m not saying it is because of your mother’s age … the anaesthetic … she might not survive.”

“Well you mean her quality of life … she has no quality of life.”

“No, I am not commenting on the value of your mother’s quality of life … she might not survive the procedure.”

As I was preparing to leave I knelt down in front of her, held her hand and caught her attention. She looked at me, smiled broadly. I complimented her on the turbaned scarf, knotted skilfully.

“When you compliment something she will offer it to you,” her daughter explained.

So I complimented her on her smile; the magnificent wrinkled ninety eight years-of-life smile. She gave it again. The stressed daughter in brown with the tall autistic son in black softened, eagerly sitting close to her mother and translating.

In one look, one smile, I was enriched. If I had not knelt before this woman, I would have missed those beautiful life-long eyes. I would have missed Christmas.


– Dr Sinéad Donnelly MD, FRCPI, FRACP, FAChPM

Sinéad Donnelly is from Ireland. She has worked as a doctor in Ireland, USA and Scotland. For the past seven years, she has been working in Aotearoa New Zealand. She is a specialist in palliative medicine and internal medicine working in Wellington. As an extension of qualitative research Sinéad has produced six documentaries in Irish and English, exploring how children grieve, ancient Irish traditions of dying, how families care for relatives dying at home in Ireland and New Zealand and, most recently, a documentary on a unique rural parish in New Zealand. Sinéad writes as a way of making sense of her world.