ON DYING AND DEATH

Death roughs us all up, sooner or later. My first round with death was as a twenty year old. I remember staring at my sister’s lifeless, broken body, neatly propped together and lovingly tucked into her coffin, ready to descend to her final resting place.  She had fallen down a frozen waterfall and landed facedown onto the snow-covered rocks, 20 meters below. Her petrified expression, fixed in time by the cold, still haunts me today, as does the sight of the coffin being lowered into the icy ground, and the deafening drumming of the snowy earth crashing onto the coffin, sealing her in her wintry grave forever.

 

My next bout was as an intern, now 24 years old, working in an admissions ward at Coronation Hospital, in Johannesburg, when I was asked to assist in the general ward with the resuscitation of a young man. My misfortune was to have been walking past the ward at the moment he collapsed. He was not my patient, and I was given cursory facts by the nurses in the ward as to his medical condition. Tragically, the resuscitation was unsuccessful, and the team involved quickly scuttled away with barely a word to each other or the nursing staff. I was new, thus slow to leave, and being the only doctor left in the ward, the task of informing the family, who were waiting outside the ward, became mine. I had no idea how to proceed. There were no courses given at medical school covering this. Healthcare is designed with diseases as its focus, not people. I hadn’t treated him before, knew nothing of him or his family, and didn’t have any facts at my disposal. What was I to say? What was I to do? My pager was bleeping. I had to get back to my ward. I did, for a few seconds, think of making a run for it. He wasn’t my responsibility. I also had my own experience of death fuelling my repugnance at the task ahead. I stayed. I cannot remember what I said to his devastated parents, but I still feel the shame of my inadequacy, and remember the relief I felt, when I could finally walk away from their damning grief.  My pager kept bleeping and I got angry looks on my return to the admissions ward. I had let the side down with my absence. I continued working through the night, and the days and months rolled into each other, and soon enough, I forgot. I never spoke of it to anyone at the time. None of us did. We were all burdened with a myriad of difficult and traumatic experiences, we were chronically sleep-deprived and stressed, and there was always more work than we could handle.

 

I have subsequently been exposed, many more times, to dying and death, and it has never got any easier. The shame and inadequacy remain. I try my best to usher in grief with warmth and empathy. Deep down, however, I am overwhelmed with dread, and feel sick to my stomach.  We are trained to prevent diseases, to optimize health, and to save lives, at all costs. Anything less feels like failure. Western Medicine thrills us with its amazing contributions to quality of life and longevity. There are record numbers of people living longer, and also, filling our wards and ICUs. However, we are ill equipped to deal with these frail, chronically ill and terminal patients. We use the wonderful tools at our disposal to keep them going even longer.  We pour over their charts, discussing their vitals and progress in our ICU rounds, barely looking them in the eye, or having a conversation with them. Despite our best efforts, so many are dying a sterile, lonely, disempowered and brutal death, suffering unnecessarily through our interventions, in hospitals, hooked up to our magnificent machines, with doctors like myself, who are not comfortable with the idea of death. We never want to give up.  I wonder if this is progress. How we die matters, and how we die leaves a lasting memory for those left behind. Dame Cicely Saunders, who started the hospice movement, famously said ‘ You matter because you are you, and you matter to the end of your life. We will do all we can, not only to help you die peacefully, but also to live until you die’. I think there is a lot we should learn from the Hospice movement.