Perhaps for some of us, death has become so commonplace that it has slowly migrated from the category of “tragedy” to “merely mundane”.
And indeed, so often in the past I have found myself shrugging off yet another death, yet another passing of a soul into the night as “well, it was about time anyway”, or even worse, ” bloody hell, now I have to get out of bed to sign his stupid death certificate and offer my most unsincere condolences to family I have never met of a patient I’ve never seen.” As a fledgling houseofficer, the prevailing thought was “shit, I hope it isn’t a coroner’s case because that would mean doing a discharge summary in the middle of the night.”
And all too often, it’s become all too easy to use constant fatigue, the ongoing sense of being unappreciated as well and the general hardening of the heart and encroaching cynicism that seem part and parcel of the dreaded process of ageing as excuses for one’s (occasionally) occasional nonchalance towards what is a heart-rending and life-shattering event to others. Sometimes, it may even be necessary – for what good can come out of shedding tears over the passing of every single dead gomer, what benefit could there be, getting all touch-feely and wobbly at the knees when there is much work to be done, even more lives to be saved?
Do you remember the first time one of your patients died? I do.
He was old, and yellow, the story of his drawn-out losing battle with the ravages of chronic liver disease and subsequently cancer written all over his bruised, bloated body like the demented scrawlings of a black-hearted scribe. The day before, a couple of eager, bright-eyed newly-minted clinical students had been standing by the foor of his bed, marvelling at his deep jaundice, tea-coloured urine in the urine bag, spider naevi, palmar erythema and patchy bruising. Clinical medicine come alive!
“Is he going to die?” one of them asked softly, and I simply shrugged and nodded.
“Yes. Soon. But it’s probably for the best.”
The next day, he had become unresponsive – hepatic encephalopathy finally kicking in – and as his breathing came in deep, quick gasps, a part of me idly wondered what his hepatic flap would look like if he was only alert enough to lift his arms out straight in front of him. But the other part of me was vaguely torn, for we had not been able to offer anything beyond a bed, IV morphine and (scanty) words of comfort. And at that moment, we were unable to do anything more than hook him up to an ECG monitor and wait for him to flatline, and offer (this time quantitatively more) words of comfort yet again.
There were many more deaths in between, some tragic, some riddled with frustration at not being able to do somehting more, others met with a nonchalance that was even then just a little bit disturbing in a little corner of my mind.
Yet even until now, every now and then, just when I’ve written of all my humanity, just when I’ve dismissed my capacity to be moved by patients, something happens that makes me think that maybe, just maybe that wide-eyed, idealistic boy who could have once unflinchingly said “I want to be a doctor to save lives” might not be so dead adn buried after all.
But that (and so much more) is a story for another day, another time, perhaps for another me to tell.
Hello. This is my first post, and I like starting things off with a garbled, depressing, unstructured rant.
And having the introduction at the end.
I hope you read on.