She was like so many other patients I had seen: thin, pale, elderly, and short of breath.  The oxygen mask and its large ballooning bag seemed unnatural and almost comically oversized on her face, obscuring everything but her eyes and the dusky, blood-matted hair plastered to her forehead.  She squeezed the bag, hungrily trying to force more air into her cancer-infested lungs.  The situation was bad.  I knew it, my team knew it, and it was becoming increasingly clear that she knew it as well.

Some of the other medical staff said that she showed signs of confusion, but her words were clear in speech and meaning.

“Oh God… This is it… I don’t want to…”

She was afraid of so many things, and we weren’t doing much to help that.  There was the strangeness of the environment, the necessary but painful things we were doing, and above all, the dreaded possibility that she could die, heightened by the worry and concern frozen on my face.  One of the attendings was repeatedly jabbing a large needle (I mean inches long) into her neck and she would occasionally moan and move feebly in pain.  I was holding her hand and doing my best to reassure her, but I didn’t know what to say or to think.  In that moment, all the isolation and chaos and alienation that has become modern medicine hit me hard, and I looked around the room littered with medical waste and harsh noises and complete strangers.  I thought, “No one should have to die this way,” and realized that it was not the first time I have thought this.

These words seem so melodramatic and cliched now that I write them, but perhaps I have the manner of things backwards.  Perhaps melodrama is so overdone because it tries to imitate these sorts of events and emotions with some reflection of their gravity and substance.  But there is no truth to the imitation, because in reality no words can express the absolute lack of poetry or grace that characterizes death.  There is no premonitory music that plays in the background, no dramatic panning of camera angles or dynamic lighting to throw the monumental event into starker contrast.  The physics and mechanics of death are unglamorous.  We often die in appalling ways: lying in a pool of our own urine and bodily waste, surrounded by alien and otherwise threatening entities, unknown and possibly unloved.  Death can easily happen in the next room without leaving anyone the wiser; in fact, that is often why people do die… because no one else knew it was likely to happen.  In so many ways, death is one of the most unmagical and ordinary things that happen.  As medical students are often taught, “Nothing else in existence is more certain or inevitable.”

And yet there is such a strong, innate resistance to this notion, one that has been ritualized in every known human culture.  We make death meaningful, as if the act of remembrance and reverence elevates the importance of who and what has passed.  Such respect is somehow written into our emotional DNA, though some philosophers (and one of my professors) have argued that this is because human beings are arrogant, elevating their self-worth something of greater value than what our naturalistic compositions warrant.

But this is not what I thought of, staring at the large needle boring itself into and out of her neck.  I did not philosophize or ruminate.  Instead, I looked down at my own hand, which was holding hers, and realized that I was the one clenching my fists the most.  I was not any more prepared for her death than she was, and for some bewildering reason, this gave me great comfort at the same time that it struck me with sorrow.

I am not sure why I am still writing, except that I desperately want to believe in the Divine.  I want to believe in persistent purpose, in the significance of death, in a life beyond what we can see and know in the here and now.  All the evidence and momentum of this great engine of the soul inside me screams for something more and meaningful and lovely and beautiful and it will not be denied, it cannot be refused, it must not be quieted.

You are witness to it.  Speak its truth to me, again and again.  I want for us to be eternal, for us to be prepared and consequently, divine.

Listen, I tell you a mystery: We will not all sleep, but we will all be changed— in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed.  For the perishable must clothe itself with the imperishable, and the mortal with immortality.  When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory.”

  “Where, O death, is your victory? 
   Where, O death, is your sting?”

1 Corinthians 15:51-55

Dedicated to my patient.