On Death: II

This post follows On Death, published on HelloMedical's website.

The bleeping of the machines had ceased. The ICU was cold and sterile, its pale, washed-out decor reflecting the often bleak outlooks of patients contained within. Standing shoulder to shoulder with the doctors in the medical team I was shadowing, we watched a family saying their goodbyes. But our patient was still alive. For weeks, we'd watched his condition deterioriate. The unlucky disease, a totally unexpected immune reaction to something rather common, had struck down a previously healthy individual. We'd watched his health improve enough that he'd pleaded with us, "when I get home, do you think we could go camping?" The desperation for his own life back - the one where he'd played sport with the grandkids, run riot around a loving wife and told cheeky jokes to unsuspecting individuals - bled out of his voice; our knowledge that he'd never be well enough to make it out of hospital again caused a well of sorrow to rise inside us. There were times that I had to catch the gasps of sadness before they turned into the furrowed lines of my own emotions. And now we were watching this previously strong man's family say goodbye to someone who was still alive. He, imparting his last words of wisdom, they, saving memories of the last moments with a dear one. The sincerity in his expressions and the desperate hope that his family would remember him not at the end of his life but as the fellow sport enthusiast and outdoorsy-type shone clearly to us at the end of the bed. His family was trying so hard to hold back the tears. Somehow, it felt like he was telling his own eulogy. Like we were watching a ghost.

And the next day, he was gone.

A year ago, I'd never seen a patient die. I'd had glimpses at the lives of patients - patients that I now know are almost certainly gone. But I'd never had a life fade away beneath my hands, nor turned up the next day to find a patient discharged to the morgue. This year, the realities of death have become all too apparent.

From the flailing attempts at resuscitation of our frail, elderly patient in PNG, whose death we postponed by an hour with an exhausting attempt at CPR, to ruptured abdominal aortic aneurysms to the exceptionally old patients who ran out of steam, caught by an infection they could no longer fight off or renal failure that could no longer be managed, there have been so many who've been beautiful influences in life and sad losses in their death. Which isn't to say that all patients make their doctors smile - just that I've been lucky enough as a student to enjoy time with people under the care of my training hospitals.

Recently, I read The End of Your Life Book Club, a tale of a man's bond with his elderly yet agile and engaging mother as she slowly succumbed to a terminal cancer. It was the story of a woman who wouldn't give up - who wanted the most of every moment. A story of a family's love through the good and the bad times. And how good and bad continually get redefined. Because when you're sick, the idea of good and bad days shifts. A good day is when the sunshine seeping into your skin means you forget about the pain or discomfort. A bad day when you spike a fever worthy of a hospital admission - not necessarily because you dislike hospital, but because it takes you away from precious moments when you could be enjoying the world.

A few weeks ago, we watched a documentary based in Oregon, talking about death with dignity. People who wanted the option to decide when they'd go - even if nature or circumstance took them before they could cognitively make that decision. Because, as people, we're in control of many aspects of our lives yet have so little control over our deaths. Because we can decide to live our lives to the max when we're well but are somehow deprived of the right to say no when quality of life deteriorates beyond what we might, at the time, find acceptable. And where there is little, if no chance, of improving even a little. And while some people would choose to live through that - for their families, or their friends, or a book they haven't yet finished writing, or to get through seminal research or because they're scared of death and all of these options are okay - it seems odd that those who are sound of mind and  can't fathom living in such discomfort are sometimes stuck. Neither living nor dying - existing without really being. 

I've spoken to doctors - people who've seen much more of this than I have - about their feelings on death. Sentiments vary as widely as they do in the general community - from a fear of dying before their ready to a calm acceptance of the future being, in some ways, out of their hands. Some specialties deal more with life-saving than others. Overwhelmingly, though, there seems to be this feeling that sometimes all medicine does is prolong the inevitable - rather than giving more life, it just takes away more death. It's hard to define where that line is - because there isn't one. Because we all make up those value judgements for ourselves.

But it makes me wonder.

How can legislation support people from all different backgrounds - culturally, religiously, demographically, geographically - to provide for what ever decision they feel fits them best?

As I'm writing, I'm sitting in a green chair, in a green dress. Though different shades, the colour is often perceived to be about the beginning. About life and growth. And hope. And as I watch the Vans and the Ugg boots, the leather loafers and the stylish pumps meander along the freshly cleaned tiles of the hospital foyer, I remember the many families I've spoken to in the lifts and the corridors of the hospital. The rushing, stressed parents looking for their children in Emergency; the exhausted son who's father and brother had both been admitted in a week and who had only been discharged himself a matter of days before; the child holding her mother's hand as the elder softly said, "I think Daddy's dying." Family visiting in this vast, confusing building that has come and will hold much despair for many, while being part of the mundane, the exciting and the everyday for so many of its employees. Employees who may one day find themselves on the other side of the bed. Growth and change and development. The cycle continues.

And I wonder. Death. We talk about it so rarely. We fear it as a society. But it's pretty much the only guarantee with which we're born into the world. And I wonder if we can ever make good decisions about life until we appreciate that, one day, it might all be gone.

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