Facing Death

For me, this post seemed to write itself in my mind.
I can almost hear the words as I go through the motions of saving a 5-month old baby with pneumonia who choked on her milk and was already cyanotic. At intubation, milk gurgled out of the endotracheal tube. Also, we, at the ER, suspected that she's already septic at that time and was already exhibiting signs of disseminated intravascular coagulation. She was bleeding from multiple sites (and even at venipuncture sites). Eventually, we had to do CPR as her cardio-pulmonary system continued to deteriorate. After 6 hours, she died. The mother, seeing everything unfold before her eyes, believing and at the same time, unbelieving, curled herself up into a ball of misery, a companion trying to console her, stroking her hair, while the nursing staff cleaned the baby, wrapping her in blankets and removing all the tubes that were attached to her body.
And at this sight, all I could think of then was, "it's unfair".
Unfair that a baby should die at 5 months and that a mother should lose such a child when memories of all labor pains and difficulty at childbirth are still fresh. And the father doesn't even know that the baby was brought to the hospital. How can any mother bear that?
I think for almost one whole night I could hear the mother wailing outside the morgue, where the lifeless body of her baby was kept until the funeral service can pick it up and until she can settle the hospital bills.
A part of me wanted to console her and shed some tears for her because I see that the situation is rather unfair. But, of course, I'm a doctor and at that time, my being emotional would be unprofessional and would not be of any help to her. Rather, it's more important that I console her by telling her why it happened and to assure her that everything that can be done to save her baby has been done. A touch on the shoulder and some carefully chosen words to inform her and console her, showing her that I understand what she's going through, would not totally alleviate her burden and suffering, but it's a bit of help. And it's what should be done.
This is but one of the numerous situations that most doctors in hospitals encounter almost everyday of their practice. And because of this, some people come to think of doctors as unfazed by the idea or sight of death. In some ways, it is true, for even at the beginning of medical school, as we look down for the first time at the face of the cadaver we're studying in anatomy, we're taught that death is not to be feared, but rather a state of the human body that is caused by a lot of things, both avoidable and unavoidable, curable and incurable. And the sight of death gradually setting in is also not to be feared, our professors say, as we, when we were medical clerks and interns, first witnessed our patient having cardiorespiratory arrest. Rather, impending death, should be acted upon, but on recognition of the inevitable, we should learn to let go. And I believe that letting go is probably the hardest lesson to learn in medicine.
And it is in the years of medical practice that one learns this hard lesson. Often I was troubled by deaths under my watch during my first few months as a hospital physician. Did I do something wrong? Did I follow the protocol? Have I done everything to prevent those deaths? Why should this patient die? These are the questions I often asked myself then. And it could be frustrating to be haunted by questions like such because it can leave one doubting his own competency and it impinges upon the doctor's affection for his patient, an emotion and bond that is quite expected of someone who's diligently cared for another person. However, in an effort to prove that one is so determined to save a life, sometimes one forgets that there are times when nothing else more could be done and one should not be frustrated by it. But after a while, a doctor learns when to let go and he is continually learning how to cope.
So, does familiarity with death and the events leading to it make me indifferent to it? No.
I only need to realize that, though nobody has found a cure for death and that it is inevitable, it doesn't mean that I cannot do anything about it. The death that I'm dealing with, as a doctor, is not limited to saving that patient on my table from the pathology that could take his life away but it also includes having to deal with the impact of such on my patients' loved ones. They need my strength and they expect me to guide them in their bereavement. I need not to be as strong as steel to do this, but I only need to be integrally whole, be emotionally and mentally stable enough to absorb the impact of death on myself, and be as compassionate and understanding as I can be. Even if I do not have the power to make everything all right for them, I can do my best to at least, make life a little less unfair.


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