He hadn’t wanted to make a fuss, but Gordon was my sickest ever patient

Everything was a pale substitute for the retirement he and his wife Maggie had planned.

Gordon was probably the sickest patient ever to walk into my practice. He turned up at the front desk one morning asking, between snatched breaths, to book an appointment some time in the next week or so, when convenient. A good GP receptionist is worth any amount of gold. Gaby took one look at him, instructed him to take a seat, then rang to tell me I needed to fit him in straight after my current patient.

He was in crashing left ventricular failure, his heart muscle no longer pumping blood effectively, his skin pale and clammy, his lungs as sodden as wet sponges. He’d had some chest pain several days previously, which he hadn’t wanted to make a fuss about, and sure enough it had settled after a few hours. That would have been the massive heart attack that had killed off much of his heart muscle. His breathing had been getting progressively laboured until, in the end, he’d thrown in the towel and decided he ought to see someone.

I gave him immediate intravenous treatment and then sent him to A&E by 999 ambulance. He survived a cardiac arrest in hospital, was an inpatient for another week, and came out on a panoply of medications, already looking and feeling distinctly better.

He was accompanied by one or other of his grown-up daughters to his first few follow-up appointments. The experience had shocked them and they weren’t about to let their father’s taciturn stoicism get in the way of him seeking proper care again. They were also determined to get him to clean up his act: no more cigarettes, and the whisky would have to go as well. But as we tinkered with his tablets over the coming months, and as Gordon grew ever stronger, the shockwaves from the crisis gradually dissipated. Both daughters had young families and busy lives of their own. Gordon started to attend surgery on his own.

It was then that I learned about his hinterland. How he’d lost his beloved wife, Maggie, who had been his childhood sweetheart, to cancer the year before. With both his children settled in south-west England, it had made sense to move. So he’d packed up and left Scotland behind.

It was good to be near his kids, he told me, and he liked being a grandad well enough. Although what he said sounded superficially optimistic, his tone was weary, as though the words weighed a great deal and it took a lot of effort to drag them out. I got a strong sense of how it must be, returning to his flat after each visit to his daughters’ happy families, back to his memories of Maggie and the unfamiliar place that was now home.

Depression is a normal part of grieving, but if it takes a firm hold it can sap us of the motivation and energy to adapt to life changes. Gordon agreed to start treatment, and after a while he seemed to respond. He got back in touch with old friends from school and work days, and had a couple of trips away with them.

But when he talked about these renewed connections, there was always wistfulness in his voice. He didn’t need to explain: everything was a pale substitute for the retirement he and Maggie had looked forward to together. Whisky crept back in, first as a few drams when he met up with old friends, latterly as a resumption of his habitual late-night solace. And booze wasn’t the same without a fag in hand. He wanted his pleasures back, he explained; life was about more than simply keeping on.

He thanked me for what I’d done but said he wouldn’t need to see me again. A few months later, one of his daughters rang to say he’d been found dead in his flat – another heart attack. I wondered if it had taken him swiftly, or whether he’d felt the familiar pain and welcomed it: resolved, this time, not to make any more calls that might delay the end.