A Conversation about Death

Death is a scary word for a lot of people.

We don't often talk of dying. Of what happens to us when our ECG flat-lines, our chest stops its rhythmic rise and fall, our EEG goes silent. We don't talk about what happens when the hospital machines start beeping loudly, frightening those in those small room. We don't talk about what happens when someone we love or know is in a motor vehicle accident, or contracts meningococcal or suddenly falls over, never to stand up again.

We don't talk about it much, not even in the Medical-School world.

The study of Medicine, something I am privileged to be undertaking at the moment, covers many risk factors for morbidity and mortality, for diseases and conditions. We have lists, we have parameters. We put these in boxes to feel a sense of control over the world in which we live. To feel less powerless against the strength of our DNA, our environment, of the unexpected.  We look at conditions and discover the DALYs - disability adjusted life years - for their effect on our life.

But they don't teach us how to cope with what happens when things go wrong, when families start screaming in agony of their lose in the hallway, when patients deterioriate unexpectedly. And they definitely don't teach us what to do if that family is us, when that patient is a friend, when this experience isn't in the controlled environment of a hospital.

Last week, I walked into class and passed by a friend looking rather serious on the phone.  I waved but she didn't look up. Later, she sat a few seats down the row from me and had to rush out for another phone call. I finally got a chance to speak to her the next evening - a friend of hers had died in a motorcycle accident and there had been hundreds of phone calls to make sure no-one found out through social media. A friend with a partner and a child. A friend who she couldn't save, even if she had been on the scene. Even if she had been qualified, she wasn't there. And now this young man is lost to us, forever. Gone. A memory. A personality, a human being, a father, a husband, a friend, son, classmate... Words never said, frustrations accidentally aired.

The study of Medicine makes us feel like we can use facts, statistics, information to give us power over our fate. That, with the help of intervention we can prevent the inevitable until we have the opportunity to die quietly in our sleep after a long and fruitful life.  Unfortunately, very few people die of 'old age' and even fewer die quietly in their sleep at home. A class last week pointed out that most people, despite wishes otherwise, die in hospital, often attached to machines. Often with families unprepared for what is to come. Often in a way that we would never choose to go ourselves. Often in ways that health professionals really wish they could avoid for their patients, because being attached to so many machines and being pumped with drugs in one's last hours can prolong suffering for all.

A month ago, I read this article on Zocalo about "How Doctors Die".  I wondered about what I've told friends and family about my end-of-life wishes. I, like many others, want a painless death. Preferably one when I'm old and grey, happily having done everything I really desired and having lived life to the full. A completed bucket list. I do consider that reality may not be so kind. I may contract a deadly virus or have my body turn against itself. I may get stuck in an accident that empties me of vital resources to keep going. Whatever happens, I feel like I don't want doctors to do 'everything in their powers' to keep me alive. While having fewer of my current abilities may be acceptable and I may adapt following any potential incident, I would also prefer not to have my life extended by a few days or weeks that might be spent entirely in a coma. Hours and minutes in which my semi-existence leaves room for hope to brew in my friends and family. Time in which I may be aware of my state but unable to express my pain, emotional or physical, to those around me.  This may not be everyone's wish and I respect that. But this is my wish.

I feel that part of life is learning to accept death. We can fight against it, we can do our best to avoid one coming early but we cannot avoid it completely. As the only current certainly of life, I feel that we should consider how we would like to die given a variety of possible circumstances. We should share these wishes with those who might be around when decisions need to be made. I know I would like to be an organ donor. Having that conversation with my parents is not easy. Talking about death, however, normalizes it as a part of life. It takes away a lot of the fear. And it makes it easier to deal with the grief.

This is the beginning of my conversation. This is also taking hold of life.


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