Reflections on Death in Daily Living

Death. We say the word and instantly shudder. It is something our subconscious has decided to suppress from our mind. We constantly fight death – outsmarting it with medications and treatments. We study endless pathways and algorithms about death and read about it in our books. Death is looked at as a third party, something completely objective: a statistic, a number, a word on a page…until it is seen almost every day. I haven’t thought about death and dying more in my life than in the past month and a half. I know I still have a lot to learn about it, and not just in books or journal articles. 

I remember the first time they told me about our patient dying. I sat there in silence – not knowing how I had become so emotionally invested in someone I barely knew. As poignant as this moment was – it was not solitary. Death came to haunt me again….and again. It is such an odd feeling listening to someone’s pulse slowly dwindle away on doppler ultrasound as they peacefully pass. It is surreal, shocking, and humbling all in one moment as a patient exits this life and passes away. A final dignified departure. One moment they are there, and one moment they are not. Often, death passes as a somber sentence in a short conversation amongst the daily business in the hospital. A few words are said about the sadness and misfortune of the situation, then all operations go back to “normal” as if nothing has happened. Everything seems fine, almost routine, but then death becomes personal. It becomes the name on your rounding list that is no longer there, a patient’s smiling face you don’t see again, a chart that asks: “are you sure you want to access a deceased person’s record?” 

It haunts you in your moments alone. Tears on the way home. A heaviness on the shoulders as you take a shower or deep thoughts about life that have never crossed your mind before. A nagging thought while you talk to one patient about getting to go home, while just coming from a room where the patient will never see home again. A surreal experience as you ask yourself: “Did I actually just see that happen – was this a dream?” Then there are some of the scariest thoughts; the ones of putting yourself in the patient and loved ones’ shoes:

What if it was me that was diagnosed with a devastating disease? Or my family or friends? How would I feel?

How would I feel if they told me there was nothing else they could do? 

How would I feel if they told me I had just days or hours left on this planet?

And then it hits you. You realize the immense tragedies of death and impending death you’ve seen that week that were magically suppressed. During the day our minds block these thoughts from us since it’s too much to handle. We make it routine and sum death up into vital signs and lab values: blood pressure dropping, heart rate increasing, kidneys failing, respirations labored – it is a hopeless algorithm you wish you could stop. Oddly enough, it’s eerily normalized as something that unfortunately happens to people in the hospital. I mean, I guess it happens to all of us, but we always think “it’s never going to be us.” 

For fear of sounding robotic and unempathetic, we have to think this way: it allows us to function, take care of patients, and deal with the emotional turmoil surrounding death. Sometimes the patients don’t even look like they are dying and you blissfully forget the harsh reality as you talk to them about their favorite food or drink, listen to their beating hearts, and feel their pulses. And then the next day you look in their room and a new patient is there, completely unaware of what has happened the night before. In these moments we feel the deep sting of death and intense emotions fill you from the core. This is the human part of medicine. You can not lose yourself in the tragedies of others, for it would be too much to bear, but for the time that you are part of the patient’s stories you can immerse yourself in their journey and try to bring light to darkness.  

In bringing yourself into this timeframe with the patient you have to realize that death is the next chapter for the patient and we are given the honor to help them be as comfortable as possible for it. It is important to see death from the patient’s perspective. There is no wrong way or right way to die. It is as unique as the person experiencing it. Some patients accept death in a spiritual way and find peace and solace as they tearfully sit and ponder the altered plan of their lives. Some do not want to suffer and just allow themselves to naturally decompensate saying they have lived a good life. Others fight it until the end, in denial of the impending future or in a fight of determination. Some talk about more treatment and future plans, and then two days later they are gone. A few are so sick that they never knew this was the end: they had a headache for the past couple months and now they have brain cancer. Others have lung cancer and are drinking their last cup of coffee like every other morning with no knowledge that they have only 12 hours left. 

All of this makes me think, and think and think and think. First, death is such a personal process; it is a right. It is important to respect the patient’s wishes and allow them to pass with dignity: making their life the best you can for the days they have left. It is just as much a responsibility as a physician to help fix a fatal issue as it is to help the patient when the issues can no longer be fixed. Sometimes this looks like getting some juice for a patient, listening about their family, calling their loved ones, giving a bit of normalcy to the situation, and standing in silence recognizing the preciousness of the patient’s life as they pass.  Second, death isn’t a process that is experienced alone. Death involves the patient, the family, the friends, and what may seem as a weekly occurrence to you is a once in a lifetime for them. Death is also a process for the healthcare workers: one of sadness or defeat – the pain of losing a sweet patient that you unknowingly saw for the last time, or the wish that you could have been there holding their hands as they took their last breaths. A wish to have closure with patients as simultaneous, frantic thoughts fill your head on how fragile and short life can be. Third, we are all dying at different rates. I’ve talked to patients one morning about their coffee, hear them talking about how tired they are, or how they are craving juice, and the next day they are gone. You walk past their room the next morning to see another patient in it and that alone fills you with appreciation for the fragility of life. Lastly, death, even when expected, still surprises you. Sometimes death takes hours and other times years. Sometimes patients are expecting it while others are not. Nevertheless, death leaves you in suspense and sometimes even brings a morbid paradoxical relief of suffering. Sometimes death does not even make sense – it has no algorithm. It finds a way to reinvent itself and outsmart us. 

Being in the hospital has helped me to appreciate the fragility of life and the blessings we are given each day. Our time is precious. Life Is something to be enjoyed because we do not know when we will not be able to enjoy it anymore. Death, even as it destroys the body, has shown me the miracles of the body as the organs show their last efforts to preserve us. It has shown me resilience. It has shown me that people who are dying are people just like me, and sometimes they look oddly normal, drinking and eating and conversing up until the last second. You see their shoes and torn clothing in the trauma bay or you hear them talking to their family on the phone. And then you get a dose of reality as you tear up hearing the family say “I love you so much – I wish I could be there with you.” You imagine the unexpected phone call the family is going to receive that their loved one has suddenly passed away. Then, you remember a patient is not a room number but a person with a life, a job, kids, a pet – just like you.  They loved their lives just as much as you – they did not expect this, they are scared, and are sad to leave this world and everything behind.  Death is something we can’t fight as there is no cure, and sometimes the best thing you can do is take a moment to recognize the patient, acknowledge their journey, and optimize their time on this planet. 

Now, death makes me shudder a little less. It’s a process. I am now filled with gratitude that I have the opportunity to take part in such a sacred time in someone’s life.  It’s a unique time to connect, empower, and show empathy to patients and families. It is a moment to put yourself in their position – to have a human connection amongst lab values and vital signs. You realize that there will be a moment when the patient will no longer be receiving drugs, treatments or tests. We will have reached the end of the algorithm and begin the unknown algorithm of death. A blank space then appears to fill with prescriptions of love, dignity, understanding, peace, and comfort. 

Feature photo by Raychel Simpson, Class of 2020

Author: Natalie Ivey