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.


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.