Let’s talk about death and the dying.
I know, I do this a lot. It’s like death is a ‘favourite’ topic for me.
So, it’s still Friday right now and I’m still in medical oncology. (I’m not sure when this post is going up. It may be today. It may be some time next week) A patient passed away in the ward. I’m hanging out in the library just waiting for my resident to call so I can observe how to ‘certify a body’.
I’m sure you remember my little freak out three weeks ago. But after much reflection, I must face my fears. So when my resident asked if I’ve ‘been around dead bodies’, I said ‘yes’.
We walked in and saw the family briefly earlier. With all the emotions in the room, and the crying members of his family, I couldn’t help but get a little emotional myself. Yes, yes, Grace is a sap. But his daughter could not have been more than 15 years old and she was sitting on her mom’s lap.. it was all very sad.
As with all dead bodies, he was pale, he was still and very quiet. They genuinely look like they’re asleep. During the ‘certification of death’, the doctor has to check for response. That means calling out to the patient, physically trying to wake him/her up, checking for pupils to respond. I don’t know how that’s going to be like. I’m going to wait and see what happens later and update this post.
There are a good number of patients that I’ve seen that have a ‘poor prognosis’. They’re likely to live for a few months or less than that. One of them was told today that he may not live to see Christmas this year, so maybe it would be best to see his family as early as possible and get things sorted out.
That’s like a kick in the teeth, isn’t it?
Death and misery everywhere. Oncology is a serious business. It’s not jolly happy times- it’s people coming in knowing that they’re hanging out with the Grim Reaper all day. That must be a heavy weight to carry.
One of the patients mentioned yesterday that he hopes to be able to go downstairs and have a cup of coffee with his wife today. It’s the little things that matter at this stage.
Once upon a time, I thought I was cut out for hanging out with Death. But maybe I’m not. I’m not as stoic as I wish I was. I’m far too emotional and I get attached to people too easily sometimes.
So, I did the certification with the resident. I will admit that I felt quite a chill doing it. The room was quiet, rather gloomy. The blinds were drawn. It was just the three of us, two living, one gone.
The patient was in his bed, pale like he was before. His eyes were taped shut. We had to remove them. “You can always tell when someone is dead. They look like a wax figure,” my resident says.
We had to put on gloves. I chose the wrong size at first, having to go back and get the right ones. I struggle to put them on- anxiety? clammy heands? I don’t know what it was. It’s not like I have never worn gloves before.
“We have to check for response now, so that’s calling the patient’s name, doing a sternal rub..
He calls the patient’s name. He does the sternal rub, which is when you use your knucles to forcefully rub on the thin skin overlying the breast bone. Try it on yourself. It hurts. That usually elicits a response from someone who’s alive- a moan, movement to try to shove you off.
He had none.
“Now, we have to assess the tone. Once it’s a few hours after death, rigor starts to set in, rigor mortis, you know… try to move his arm.”
I felt like someone was squeezing my heart. I have never touched a dead body before this. I have touched my dead dog’s body, but not a human being’s. I have been for funerals, don’t get me wrong, but those bodies are in their coffins, behind glass and wood, preventing contact. I don’t know if my hands trembled, I don’t know if my resident noticed if they were. I touched his arm, I tried to move it from where his family undoubtedly placed them, fingers almost interlocking.
The joints were rigid. I should not have been surprised.
“Okay, listen for heart sounds, and lung sounds. Place your stethoscope on his chest, we’ll listen together.”
I am ashamed to say that I was a little afraid that I would hear breath sounds, or a heart beat. I am more ashamed to say that I actually thought to myself, “If he wakes up, I won’t scream. It’ll probably be a loud gasp at most.”How selfish and distasteful is that. How disrespectful.
The pupils were the final step. His irises were blue, surrouding the dilated center. No shrinking to light, no flicker of movement.
We discarded our gloves, my resident called time of death.
I left not long after, there wasn’t any paperwork that I could assist with. There was this feeling, the same one I felt when I was in forensics. That weird ‘uncomfortable’ feeling of seeing someone dead. I don’t know the right words to describe it. It’s not fear. It’s not quite fear, I should say. It’s just a feeling of disconcertion. Just thinking about it now, days after, I can still feel it. I cannot put it to words.
My mother said that evening, “If you’re afraid of dead bodies, you’re in the wrong field.” Well, maybe I am. Maybe these almost-five-years have been a mistake. I don’t know if she’s completely right, but I know she’s not wrong, not 100%. Death is a process of life. And I should not fear it. But boy, am I uncomfortable with it!
Does this require ‘practice’? Can you practice being ‘comfortable’ with loss? Should I immerse myself in an environment that caused me to have a visceral reaction, like those however many minutes in the morgue.
Would I be less of a doctor by being uncomfortable?
I don’t know anyone in my batch who is comfortable. Maybe that is a failing of the way it’s taught in my course. We never dealt with dead bodies in anatomy. They could not ‘weed out the weak ones’ early. I am one of those ‘weak ones’. I am uncomfortable.
Maybe it’s part of the process. And in some ways, maybe it’s good that I still feel something, rather than feeling nothing. I’m sorry that it upsets my parents so much that I have a reaction.
I can’t help it. I may have had my own share of ‘near misses’ with Death in my life, but that does not mean that I am happy in his company. I am not his friend- I thought I could be, but I’m not.
Is that wrong?