A reflection on death and dying in the hospital

I almost met death today. He was looming in the air. I could feel his presence leave right before I arrived in the morning and linger after I left in the afternoon.  It wasn’t me he was visiting but I still felt blown away. 

When I first arrived to the hospital my resident greeted me in a chipper voice, “good morning- have you ever pronounced someone dead? Want to come do it.” Sure it was 6 am, seemed like a perfectly normal way to start your day!?! So off we went through the tortuous halls, up and down the stairs until we reached our destination.  The moment we walked in the room I was reminded of my cadaver, how I was able to cope with knowing she was dead because she looked so dead and felt so dead.  I always thought it was the formaldehyde they shot through her veins prior to our first meeting.  But here I was meeting this man for the first time, and he was formaldehyde free, only a short while since his life had ended and yet he looked just like the expression “you look like you got the wind knocked out of you”.   Pale and glazed over, I did not have to feel for his pulse to know his soul had left his body.  We did our ABCs (Airway, Breathing, and Circulation check), closed his eyes, called out the time and marched on to attend to those patients whose life was still present.

Hospitals are funny places- are they there for people to heal? No I’ve learned they are more a place of stabilization- make sure the patients are not in any acute danger, ship them out to heal at home under the care of their GPs, and hope that someone will be home with them for the healing process.  This concept was a surprise for me, it wasn’t what I had hoped or imagined.  I find I have such difficulty letting patients go without a clear diagnosis, prognosis or solution.

We rounded on half of our patients in the morning and left the more long-term cliental for the afternoon.   After my afternoon slump  (that often occurs post prandially during our lunchtime lectures) my team shuttled off to round on the afternoon patients.  Outside the room of the first patient a resident filled us in on his overnight activities and what the plan of care was from here out.  “Ok shall we go see him?”  The attending asked.  One behind the other we filed into his room and surrounded the bed looking down at him.  “So how do the tests look?” the patient asked.  “The tests came out alright, the cancer has remained stable.” “Oh that’s great news, I’m so glad to hear it.  So where do we go from here?” “Well sir, your cancer is pretty far along, the treatment we could give you now would only be palliative- it would help with some of the symptoms you have been having but it won’t cure the disease. “ “Well I want to continue the treatment, if everything looks good right now we might as well keep trying to fight it.” “Ok sir, we can continue to give you the chemotherapy, but I think its important that you understand the cancer will not ever be beat, just slowed a little bit.” “ You know you are the first person who has said this to me, everyone has beat around the bush and no one has been honest about my prognosis.” “I’m sorry, I’m sure this is hard for you.” “It’s alright”. And then we moved on to the next 3 patients, having similar conversations with each of them.  Shuffling from one to the next no one spoke in between, we just delivered the bad news and moved on- leaving the patient alone in his room.   

After seeing all of the patients our attending went back to his office and we (students and residents) went back to our team room.  Everyone started working away on the computer to get things done.  “I’m sorry I know you guys are working- but I’m having a hard time with processing what just happened.” “What do you mean?” “I mean how do you guys deal with telling so many people they have terminal cancer? It’s really sad.” “I guess we just become callous to it, don’t really internalize it and move on with our day.” Oh ok.....(is that really what I'm supposed to do?)

The View from my house when I lived in Puyo Ecuador.