On Death

This is a serious post.  Consider yourself warned.

You can't be in medicine for very long before you start running into death.  I made it 2 weeks into my surgery rotation before I saw a patient die.  I was on overnight call, and one of the patient who we'd operated on a few day earlier was moved to the ICU because of a failing heart.  The night resident and I hung around the ICU for 3 or 4 hours, adjusting her meds and calling consultations.  We were sitting outside of room when she 'coded', and immediatly the ICU staff lept into her room and started CPR.  As I medical student, my job is to stand quietly in the corner and do absolutly anything I'm told.  I was told to find out where her family was staying (they were from out of town, and had been at a hotel), call her hotel and tell the them to come in immediately.  At this point it's about 3am, so her daughter must've known exactly what I was going to say as soon as the phone rang.  But I still had to say it.

I know how devastaing, heart-breaking and terribly sad death is.  The thing that I didn't know about death until that night, is that it is very awkward.  There is the awkard moment when the doctor decides to stop CPR, and everyone who had been frantically running around and pounding on her chest just stops.  The awkard moment when you see a mostly naked body left connected to a million machines; but none of them are beeping or flashing anymore.  The awkward conversations as everyone leaves the room; and leaves her alone, naked, and dead.  No one knows what to say to each other, they all just hover outside the room, mostly quiet, and saying awkward things like 'At least she died in peace'- although it looked to me like she died somewhere in the frantic mess of CPR, injections and doctors and nurses shouting back and forth. All of it was so awkward- as though I'd walked on in something that I wasn't supposed to see, or was easedropping on a deeply private coversation.  This was her death; and it was messy and strange; and I just stood and watched.  Death had never seemed like a personal and private event until that night; but I felt as though I had violated her privacy by watching such an intimate moment.

It seemed so awkward to watch everyone returning to working on whatever they were doing before the code- checking on other patients, filling out paper work, checking their email, have a snack. I watched one nurse sit down and finish her sandwich. I guess I didn't expect her to throw it away, just because a patient died, but it was still odd to see her go back to business-as-usual. It seems strange to be a part of a death, and then get back to work once its finished- but it's what has to happen unless you want to be part of another death. When it's someone you know who passes away, there is so much mourning and grief. But the doctors and nurses didn't know this patient- she was already unresponsive by the time she was transferred to their ICU. To them, this was the death was of a body- not a person; at least not of any person that any of us really knew. So the death wasn't a loss to them, it was an event- a discrete event that was properly managed, and then they all needed to move onto whatever event needed to be dealt with next.  (Of course, the staff was all so warm and sympathetic when the family arrived, and I feel like they provided them great comfort.  But until the family arrived- it was back to work)  Part of the awkwardness must've stemmed from attending the event called "Her Death" with a group of strangers, but feeling that this event was so distinctly separate and unrelated to the events of mourning and grief that would follow. Death and grief are so intertwined that I never imagined witnessing one without the other. Like watching a sitcom without the laugh track- the pauses that should be filled with laughter just hang there; and these moments that should've been grief-filled were so glaringly empty. There were absolutly reverent moments following her death, but definitly not sad moments.  And it was awkward not to feel sad.  Awkward to make a cup of coffee as the family contacted funeral homes. Awkward to go to my on-call room afterward and try to go sleep for an hour before starting the next day of surgeries. It felt like I was breaking the rules of 'death' by moving on; but I hadn't lost anything, I had nothing to grieve.  All I had were lessons to learn- what went wrong (if anything), what could've been done differently, how would I have run the code, how to comfort a devastated family.  

I think there are 2 distinct deaths that occur at the end of our life: there is Death- as the marker of the end of earthly life- which is emotionally devastating, full of mourning and grief for the surviviors; but then there is Death- the actual event- which is a strange, awkward and deeply intimate drama, played out in front of a room of strangers and medical students who will soon return to their sandwichs and textbooks.

I've had a few brushes with death since then- but I don't think you ever forget the first time.  Death is ultimately the enemy that every physician is battling; and it'll probably always surprise me what an ugly enemy it really is.  I'm amazed and inspired by my near-death patients who have come to peace with death and dying- because the whole process still makes me feel very awkward, uncomfortable and unsettled.