Tuesday, October 10, 2006

Death Becomes Her

How do we all deal with death?

It's a significant milestone for a physician to encounter their first death, to have a patient finally succumb to their multitude of illnesses despite their best efforts - and the mind-boggling barrage of superantibiotics and inotropic bullets pumped into their veins. Sometimes when it's time to finally let go, there's really not much that modern medical science can offer - apart from a call for prayer.

On table!
What's gonna happen next...

Sometime ago ( seems like a lifetime ago when it's actually been five years ) when I was a nervous, fearful house officer / intern making my first baby steps in the hospital wards, I encountered a cheerful teenager with a bleeding disorder. Playing football was his life and getting swollen knees with bleeding cuts really bummed him out. Thankfully at that time, all his blood investigations were in the normal range, he had finally stopped bleeding and most of us felt he was fit for a discharge the next morning. Pleased with the announcement, his doting father had brought over a late supper of satay for his son, talking to him as they shared their simple meal.

Well, there's nothing certain in life. We can do all we can, hope, trust and pray but in the end, some things are actually left to fate.

One small ineffectual cough was all it took - which led to a torrential outburst of fresh blood from somewhere deep inside. Just my first few weeks into medicine and to see that gushing river of scarlet pumping out of the kid's slack mouth had me staring for at least a full second before I started yelling orders.

One hour was all it took. And he was gone. Fortunately since I was too much the naive, wet-behind-the-ears greenhorn, my thankfully far more experienced nurses had the forethought to shut the curtains - which were sadly blood-spattered at the end. At that time I also had a senior resident on hand to break the news since I was much too shaken and shell-shocked after that to do it alone. It's never easy being the bearer of such bad tidings. Especially to a grieving father who was convinced that the last satay had erroneously caused the injury.

As doctors, our first encounter with a dead body is typically in the first year of medical school. That cold, anonymous cadaver we share tutorials, scalpels and lunch with for the whole semester is treated as an object of learning rather than invoking any emotional responses. You don't know their name, you don't know where they came from, you don't know what they did when they were alive. You don't know how he lights up when his father walks into the ward at 7 in the evening.

They certainly never taught us that the death of a patient is infinitely more devastating.

One of my junior colleagues had her first a few days ago. I could see the anguished look in her face and remember my first, could easily see what was going through her troubled mind. What could we have done? Could we have changed the management in any way? If only we had known what could have happened? Too many coulds and ifs. Too many imaginary variables. First and foremost, physicians are trained to heal their patients and for most of them, a patient's recovery is a success; death is an unforgivable failure.

Most doctors use something akin to denial to their advantage, building a hard, protective callus to get them through some rough spots in their practice. And somewhere along the line, some form of emotional blunting is acquired, distancing themselves from the patients without investing emotionally. These two techniques, denial and emotional blunting, allow a doctor to remain coolly composed and almost clinically detached when facing the most grotesque situations. Unfortunately for most laypeople, this sometimes leads them to believe that there is a serious lack of compassion among doctors.

Seriously? It's just the opposite if you ask me.

26 comments:

thompsonboy said...

Has anyone cute died on you yet?

ikanbilis said...

i just hope there are more and more positive minded dostors out there like you. i remember once seeing a doctor gone mad and in anguish because he lost a patient. i hardly see things from a doctor's perspective but i could see better through ER and I miss Dr Green..

Anonymous said...

duhz.. personally i really can't suit into these jobs tat require me to face the death. I'm very emotional in facing death eh!

Anonymous said...

duhz.. personally i really can't suit into these jobs tat require me to face the death. I'm very emotional in facing death eh!

Ban said...

That's nothing short of horrible! I wish it could be a little less harsh.

Guess we have a lot to be thankful for.

Musang said...

when we took my late brother to the hospital to confirmed his death and for the doctor to write the death cert, i cried the whole day and desperately wants him to breath again. desperately wants the doctors to work magic and stuff.

only weeks later that i realized, it's a god will, and no one can stop death.

not even doctors... and it sux.

jase said...

you sound like a social psychologist/counselor teaching about how doctors deal with death.. ever wonder if you would change fields and join me in a world of psycho?! okay.. sounded a bit weird there.. a World of Psychology?!

Anonymous said...

Sounded like a scene from Grey's Anatomy where Christina just couldn't let go of that nurse lady (who died) in the first few episodes from the first season. It's really nice that you enlighten we plebeians and show us that doctors aren't all emotionless zombies and that they do have feelings especially when it comes to death. God bless you, paul.

nyonyapenang said...

emotional blunting? it has to be like that because i believe, if a doctor is 'too emo', he can't perform professionally.

Anonymous said...

It's all fate. Only God decides when we live and have to leave. I salute you, paul and the other doctors as well who are saving lives every single day! Admiration beyond words.

Las montaƱas said...

This emotional denial is dangerous.. if the floodgates burst, it can lead to a serious mental breakdown.

Sam said...

It hurts when someone dies, and doctors definitely face this emotional risk. I can't imagine how it feels - but I guess it must really hurt when you lose someone you thought you could save.

Which is why we're proud of you - and we respect what you do because although it may be tough, someone's gotta do it - and you have to be strong for those who are weak. After all - where would we be without the strong-willed doctors?

They are out there, saving lives everyday. That's what you do Paul - and we salute you and all who work alongside you. For humanity!

Thanks for sharing the world through your eyes. It makes us more thankful for everyday we spend living and breathing.

Annie said...

I know where you're coming from Paul. Working in hospital settings, you get to meet and know patients who are there one minute ready for discharge then dying unexpectedly overnight.

We expect doctors AND nurses to handle these types of situations with ease. Also police officers, paramedics, firefighters have the same issues I'm sure. A human being does what he/she can to do his/her job. If they needs to detach themselves, we have to understand that and allow it. You need emotional support? That's what ministers and social workers are for. Everybody has a job to do to save lives and save the spirit.

Roxanne said...

Dude. I'm, like, totally depresso now! :(

Anonymous said...

thanks for sharing

I can remember when my first patient died on me ... I was also a houseman...and everytime I closed I can see the patient's face for a week....to study for so long and still feel powerless .... in the end I am humbled and realise how fragile life is and that God alone holds our lives in His hands...

Anonymous said...

Is there more to Life without pleasure and pain? Yes, thats DEATH.

Colin said...

Hang on in there... its amazing what you doctors do and just wanted to say how great it is for you all to put up with all this baggage.
Are you in surgery? Are you as sexy as McSteamy?

ian said...

Sometimes it is necessary for us to retain our professionalism in our jobs, especially ones that require delicate devotion and focus. I guess some departures are inevitable, and all we can convince ourselves to rid the guilt is that when we have tried our best... I personally manage to appreciate this post at a greater depth. In some way it has brought some optimism to my soul, albeit its depressive exterior.

Annie said...

Yeah khalel is encouraging me to start a parade! LOL!

nemesis-on-fire said...

emotional de-sensitizing. because if one gets emotionally attached, one probably gets affected and it might affect performance. but still, a gruesome lesson. coughing blood and spattering it everywhere. OHMYGOD!

Anonymous said...

i would've passed out seeing blood spattering all over. seriously.

but, it is interesting to read a different post from you...the, er, sensitive side of you ... hehehe.

watching Grey's Anatomy made me realise that docs have the worst job in the world. it's darn painful to see a person dying or died. worse, if it is a kid (for me, personally). i will cry buckets. seriously.

William said...

It took me a whole 30 minutes before I reacted to seeing my father's lifeless body on the ICU bed. Only then did it sink in.

When one sees death on a daily basis, wouldn't one get desensitized?

ec said...

That is one of the reason I am in IT line rather then nursing..=)

a.o.d said...

Well said. Again, your post is spot on. After so many years, I no longer remember who is the first patient I lost, maybe because I don't want to remember.

Spot said...

The problem with emotional blunting is that some healthcare workers use it as an easy way out of actually trying to reconcile professionalism with basic humanity - seeing the patient as a person.

The true professionals are those who keep their personal feelings in check WITHOUT sacrificing the compassion that a suffering person needs.

Too often you hear patients complaining abt being treated as if they were faceless, non-persons. Where does the mask of emotional blunting end and the face of cold business sense begin?

I think that ppl who choose to go into medicine need to realise that the fundamental principle shd always be clear...it's not abt you. It's not abt how incredible your skills are. The nobility of the profession does not arise from the healing of the sick, but from the sacrifice of self-interest in undertaking such cause.

Good post, this.

Chalks said...

beautiful words. i have yet to lose a patient directly under my care, but many of my patients have died mid-way through their treatment course. for these patients, their passing is a blessing. they arrive at our department in such pain and we are the last resort to offer some sort of pain relief. we do all that we can, but sometimes that is never enough. the only cure for their discomfort is death, and every time one of these patients pass away, i can't help but feel thankful.

sounds horrible doesn't it?

but the way i see it is, i have to be tough and look at the bigger picture. people often wonder how i do my job. i see my job as simply providing a service that a patient has requested. it is purely elective. if by chance things don't work out, i know i did all that i could.

i admire the medical staff who work in situations where death comes as a surprise, not a blessing.