My brushes with death (My patient has died Part 7)

It’s said that after birth, the only guarantee is death.

I think that’s why, when asking me to throw in my two cents, Joy didn’t start with ‘have you ever lost a patient?’. Instead it was, ‘would you want to write about it?’, with the assumption that, especially as a medic, I have had my brushes with death. 

I don’t have a specific story though. When this first came up, I didn’t immediately think of one particular patient – rather, my first thoughts were the products of a number of experiences – so instead I’m going to expand on the common elements of what I’ll call, for lack of a better term, ‘the motions’. 

It’s almost like a set script. As a medical student, you meet a random patient. Maybe you find them on the bed assigned to you. Maybe they’re the only one who was awake when you went to ‘clerk’ (a term for talking to patients and getting their histories and examining them)…or maybe you just happened to be in the vicinity when they wanted something and you ended up talking. It doesn’t really matter. The outcome is the same: contact is established.

This is a different type of acquaintance that you make though. You start off as complete strangers, and within an hour’s time, you’re…not friends, exactly, but a semi-intimate bond does form. By the end of the hour, you know all about this major turning point in their life – the thing that’s brought them to hospital (which to us isn’t a big deal, but for any ‘civilian’, I can appreciate how significant it is) – as well as a lot of other details that you don’t share on the first meeting with others, such as their family trees, other illnesses they’ve battled…and sometimes even how many windows their homes have. In and of themselves, most of these random facts have no bearing, but they do serve to make you feel a stronger connection to the stranger before you

That’s step one. 

Things can progress in a number of ways then, depending on the specific condition, but often there is a phase of ‘strengthening’ that connection. It’s small, daily advances you make as you check in on them to see how they’re doing, ask about complaints, answer their questions…the interactions don’t last too long, but they do serve to build up enough of a ‘base’ such that when you step into the room, your eyes first seek their bed, their eyes. You feel that rush of warmth that accompanies familiarity, and you see it reflected in their expression too, and those mini-check ins become a cozy little daily ritual that you don’t think of too much.

Then one day you find the bed empty, because they’re dead.

Was that jarring? 

I’m sorry. 

That was kind of the point though – that’s sort of what it feels like. 

I wasn’t entirely accurate, because sometimes you find a new stranger in that bed, but in terms of ‘shock impact’, it’s actually been comparable for me whether or not I knew it was coming.

Understandably, it’s the unexpected ones that shock you a little bit more, where you’re left stunned and wondering as to why things took that turn, but even when your patient was extremely sick and you knew their time had come, it still jolts you. What’s different, I guess, is that the initial ‘OMG’ is soon followed by a kind of gratitude that their suffering has ended, at least.

If this isn’t bittersweet, I don’t know what is. There’s relief for them, on their behalf, as well as sorrow, and it’s then that you realize that, despite your knowledge and accurate assessment of the probable outcome, you had been hoping that this would be the case that would beat the odds. 

At that point – the point of revelation, you’re a little dumbfounded and you don’t quite know what to say, so you ‘okay’ it and just get on with what you’re doing…and once again, each situation is different, so I can’t really even make broad strokes, but eventually you get to this point of having taken it in stride and having moved on. 

It sounds extremely callous, I know…but life really is like that. The whole experience is comparable to being hit with a strong puff of perfume – initially, it’s intense and heavy around you, but as time passes, it dissipates away and you’re left with just a memory. 

The world carries on. The file gets wrapped up with a brief summary, and the ‘deceased’ label appears next to your patient’s name in the admissions register…and that’s it. 

For you, anyway. 

I imagine this is a new, terrible sort of beginning for the patient’s family and friends, but that’s not what this is about. This was meant to be about the medical students’ perspective, and for me, after having run a number of these circuits, I’ve gotten to this a new understanding of ‘the big picture’ that I didn’t have before. 

Life is short, and in the grand scheme of things, we are so insignificant I won’t get to see what happens following my own death, but I have seen enough to make a fair approximation of how it’ll go – and the bottom line is, the world is going to carry on just fine. 

It sounds depressing and defeatist, but please don’t get me wrong: this is just a stepping stone in the stairwell that leads to my ultimate, not-so-original conclusion: our lives are but flickers of a candle against a backdrop of the Sun, so we might as well make the most of it. 

It sounds dehumanizing and insensitive to say ‘everyone will die, death is no big deal‘, but I say it with all the appreciation and reverence for life itself. Death is a given. Once you come to fully embrace that, you’re able to free up any mental energy that was spent being apprehensive about that outcome, and appreciate even more greatly the life part of the journey. 

Not that death is an absolute necessity to be able to appreciate life, of course…but again, that’s besides the point. 

The appreciation for the here and now has simply been one of my biggest takeaways. 

Another one relates to how inspiring and brave people can be. I can think of a couple of patients with poor prognoses, who knew what was coming, and were still unfazed. They weren’t stoic, really…rather, I think the word is ‘graceful‘, and it’s truly so inspiring! If they can do that with the ultimate endpoint, I feel there’s no reason I can’t apply it to everything else that happens in life, you know? 

The other strong emotion I’ve felt in this situation is…well, heartbreak. It’s so heart-wrenching sometimes to see someone’s fears, or the impacts on those dependent on them, or – and this one hits you hard an entirely different way – a parent’s pain and despair when the patient is but a child. At these points, that it happens to everyone isn’t of much comfort. It doesn’t even change anything for that family, anyhow – the wounds remain just as raw. 

I realize this sounds like an incomplete thought, but that’s really all there is to it. You see that pain, and you feel it too…and that’s it. There’s nothing else to be said or done about it.

I guess, that’s just life. 

And from my end, that’s death, too.

Aditi Vakil

Thanking my lovely friend, fellow poet and writer, Aditi for this deep sharing, quite timely in this season of the pandemic.

Do share this article with someone you think it’ll encourage. 😊 Plus, stick around for 3 more articles in this series coming by this week. Follow and subscribe to the blog so that you get them straight to your inbox!