Wednesday, April 25

Been there, Done that

Death is an interesting topic. I say interesting because while it is not one that most people like to talk about, it is something that is everywhere around us. We hear about death in the media- the latest murder in Washington, D.C., the inmate whose death sentence was pardoned or carried out, and the 24 hour coverage of the war in the Middle East. It is in the action flicks we go to see, the books that we read and the songs that we hear. The Hunger Games has provoked a controversy as to whether the depiction of children in a "death match" should even have been made into a film.

While we as a society seem to accept these examples of death, it becomes very different at a more personal level. Decades ago, most people died in their home and yet nowadays, it is more common to die in a hospital, sometimes after prolonged illnesses. Death has moved out of the personal realm into a more "sterile" environment. As if having it occur in hospitals will keep it safely away from the rest of us. Yet, of course our own death is inevitable at some point.

As a physician, I have had the unfortunate experience of seeing death first hand as a part of my job. While I accept this as being part of my chosen profession, it is always an area that is difficult.  I do not remember each person in detail but there are certain patients whom I remember more vividly than others.

There are certain milestones as a physician that I think most of us remember.  Your cadaver in anatomy class.  The first physical exam performed by yourself.  The first time you get to operate.  The first patient who dies.

I was a third year medical student doing my Internal Medicine rotation. My patient was a 40-something year old, Hispanic female with Stage 4 Lung Cancer which means that her cancer had spread beyond her lungs.  She had come into the hospital for some complication of her disease and we knew she most likely would not leave. Since she was assigned to me, I rounded on her every day.  That is, each day I would walk into her room and ask how she was doing.  I would examine her.  I would check her chart and carefully note her vital signs and any other tests that were done so I could report them accurately during rounds.  She improved a little over the course of the week and we began to think that she might be able to go home on hospice.  Unfortunately, she got much worse before we could make this happen.  It so happened that I was on call the night that she slipped out of consciousness. We started her on a morphine drip "for pain" but really it was to help the family. As death nears, a person will often start gasping for air and while it does not cause any pain, it is extremely difficult for a family to watch. Morphine helps by decreasing the body's respiratory drive and therefore lessens the gasping.

At some point in the night, I was called by the nurse on the floor taking care of her.   I went into her room and examined her for the last time. I listened to a heart that was no longer beating. I listened for breath sounds that were not there. I then had to tell the family members gathered around her that she was gone. I left as they all began weeping because there was no more that I could do.

Although you could say that I was experienced with death because I am a physician, there is nothing like experiencing the death of your own child. It is unnatural. It is not expected. Most of all, it is not what you dream of as you go through the months of pregnancy.

I think this is why people have reacted so differently to the news of Rachel's death. I am amazed at the outpouring of love we have received. So many have reached out to us through phone calls, emails, cards, gifts and even bringing us dinner. It has been so amazing.

However, there are also other reactions.

Those who don't know that Rachel died and then become flustered and apologetic when I answer them with my ever so blunt, "My baby died". Most of the time I feel like I have to help them out in their discomfort since they are so obviously at a loss for what to say.

Sometimes, someone will share with me that they too had a child die.

Some people avoid the conversation about my baby to such an extent that it is almost as if I was never pregnant. Like the whole thing never happened. I find that these people just have no idea what to say to me so they say nothing. I was really hurt by this, but more recently I have started asking certain people if they have seen a picture of Rachel. Most people have been very warm after this and it allows them to know that I am ok with them talking about her.

Then of course there are the people who will say, "I know just what you are going through. My mother died a few years ago" or my all time favorite, "Been there, done that". I was actually so flustered by that last statement that I was left speechless. I am pretty sure the woman who said it did not mean to belittle what I am going through but it still hurt.

I think that Rachel's death has made me much more aware and empathetic to parents who have had a child die as well as to those who experience the death of their loved ones, no matter who it is. The pain is raw and deep and while it sometimes eases, it never really goes away. Even now, 2 months later, I will still look at Rachel's picture and wonder if she really died.

It makes me try to appreciate each day I have because after all, I never know if it will be my last.

No comments: