In Memoriam

There are many reasons why I love medicine.  One of them is the ability to dig into the real “stuff” of human existence: life, death, suffering, love, pain, loss, redemption.  Another is the speed by which I can get down and dirty.  In less than fifteen minutes, I can go from being a complete stranger to a trusted stranger who can ask questions about that strained relationship you have with your uncle or the heartbreaking romantic fling you had last week or that strange mole on your inner thigh.  Usually these interactions involve intimate but everyday details, though there are times when it still catches me by surprise.

I was shadowing around a hospice service when a nurse came to me and said, “Come.”  She introduced me to a family who had been there for several days.  The grown children were there for their mother, who was expected to pass away soon.  They had already come to terms with the conditions of her impending death and were only waiting for the timing and that last, eternal moment in which to finalize goodbyes.  I was ushered into the room feeling stiff and uncomfortable in my short white coat, which stood in stark clinical contrast to the tasteful and deliberately calming wood tones of the hospital room that felt more like a hotel suite.  The patient had been breathing in rapid, shallow gasps of air… a pattern I would come to recognize all too readily over the coming weeks.

The family wanted a distraction.  That much was clear as they peppered me with questions about my life.  For once, I had to describe those intimate but everyday details about what it was like at my college, at medical school, working in the hospital, the weather in my town.  And suddenly, in the middle of some inane and rambling description of my suburban and otherwise unremarkable life, the patient stopped breathing.

Immediately, the family members tensed up and asked me, “What’s wrong?  You’re the doctor, right?”  In my mind, I was surprised.  After all, what were they expecting?  Did they think she was going to jump out of bed and scream, “Hey, pay attention to me!  I’m better now!”?  They knew that she was dying; they knew that this was going to happen.  I knew, and I had only been there a few minutes.  But years of hospital training kicked in and the urge to do something forced me to stammer out a lame excuse to get the nurse.

The nurse was a pro.  She had been doing this for years, and so she came in and calmly assessed the patient, whose heart was still beating faintly.  The nurse listened quietly to the beat as it faded away, gently easing the children, those grown and adult children, into the reality that their mother was now gone.  I still marvel at her skill and aura of tranquility.  The family had time to say their final words and then they left quietly but gratefully.  It was the first time I had watched a patient die without needles and tubes flying everywhere, without people scrambling for medications and defibrillators, without the repetitive creaking from a bed frame assaulted by the combined force of chest compressions on a stiff torso.  I was literally overwhelmed with the sheer normalcy of it all, and what disturbed me the most was how this ritual of death had become, for a young doctor in training, the exception rather than the rule.

When did something so routine become bizarre?  Have we learned nothing about death despite millennia of human existence and thought?  When people ask me about the life of a “doctor”, they are most curious about the thrill of working with life and death.  I see my own reasons reflected in their questions, but I am always baffled when they become uneasy when the discussion turns to their own mortality and fragility.  I have asked most of my friends, “What happens when you die?”, and the most common answer is, “I don’t know, I haven’t really thought about it much.”  More often than not, they also imply, “I don’t want to, either.”

Even though I hadn’t eaten all day, I waited by that patient’s room throughout the early afternoon because I wanted to see what happened next.  So I helped tidy up the body.  I helped straighten her out, removed the last offending bits of tubing and plastic, and cleaned up the sheets.  I helped the funeral home director transfer her to one of those black body bags you see in the movies, helped zip the thing up and waved goodbye as she was wheeled down the hallway and through a set of heavy double doors.

These past few weeks have been filled with congratulations and accolades as I receive my medical degree and move on towards residency.  I have told people not to celebrate too much yet and that the “worst” is still ahead in so many ways… and yet, perhaps there is something special in celebration because it remembers what we have come through and it looks forward to where we are going.  A book I’ve been trying to get through talks about the theology of memory, that the act of remembering is to re-live in bits and pieces.  Sometimes the act is intentional, as it was for those family members remembering inexpressible things about their mother.  Sometimes it is not, in the same way that that family continues to spring into my mind.  As we commemorate those who sacrificed their lives that we might live, let us remember.  Perhaps doing so restores a little life, dignity, and meaning to those who have died.  Perhaps it will do the same for we who share the same fate.

For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;a time to plant, and a time to pluck up what is planted; a time to kill, and a time to heal;a time to break down, and a time to build up; a time to weep, and a time to laugh;a time to mourn, and a time to dance; a time to cast away stones, and a time to gather stones together; a time to embrace, and a time to refrain from embracing; a time to seek, and a time to lose; a time to keep, and a time to cast away; a time to tear, and a time to sew; a time to keep silence, and a time to speak; a time to love, and a time to hate;a time for war, and a time for peace.

– Ecclesiastes 3


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