I have debated writing about this subject. The first death I mention actually took place a while ago, and it took me a long time to be able to talk about it at all. I feel like we talk about death in many ways - we talk about people who have passed and what death means to us in our lives. We talk about how it has touched us and how it affects our decision-making. So I guess when I came to medical school, I was expecting to deal with death. I expected to talk to people about it, to express sympathy for people who had experienced it in their family, to learn how to tell people they are going to die or that their loved one is dead.
But what I didn't really think about was what it would be like to experience the act of dying.
The first person I saw die was an eleven year old boy. He was shot in the heart by his mom.
He came to the emergency room and they did what's called a thoracotomy. This is an emergency surgery where you cut open the ribs in order to be able to massage the heart directly. You already know death is coming when you do this - survival from a thoracotomy is about 10%. They opened this little boy up and his heart was shredded. They pronounced him dead.
No one really talked to me about it afterward, besides my preceptor saying "that's fucked up" - which is about the best summary I can think of. It was numbing. The ugliness and brokenness of the world we live in was so vivid to me that day. I turned on the news when I got home that night and heard some personal details about him, but I had to turn it off because I couldn't bear it. I couldn't bear to personalize it. Kids aren't supposed to die. They are resilient. They recover.
They definitely aren't supposed to be shot by someone who loves them.
A few weeks ago I watched an old man be coded and die. They did CPR and pushed epinephrine and intubated him. About half way through the code his wife came back to the room, realized what was happening, and began wailing and saying "it's over" and calling all their children. The team continued to "work on him," but after 20 minutes he still had no pulse. They pronounced him dead.
I didn't know him well. He was one of the patients on my team but not one I was following. I had met him once about a week before. At the time he just kept saying he was thirsty.
While he died, I was just overwhelmed by the ugliness. Death, especially death in a hospital with people fighting to keep you alive, is terrifying to watch. There is no dignity. It is not peaceful or romantic or even sensational like it seems in tv shows. But after he died, all I could think was: at least it could be worse. Nothing seems quite as bad after seeing a little boy die from being shot by his mom.
Death and dying are hard to talk about because we're afraid to be "morbid" or "depressing." I hope, in reading this, that you aren't too depressed or fearful. Because the opposite of death is life. You are living! All we can do is live each day God gives us. I wish I could end with more wisdom, but at this point all I can say is that experiencing dying changes you. I hope it changes me for the better.
