We, the dying
“So how do you spend your days?” my cardiologist professor asked our patient, in an attempt to have an idea of his lifestyle habits. Our patient was 86 and generally healthy, presenting himself only for a routine check of his pacemaker, placed the year I was born and functional ever since.
He responded sullenly: “Waiting for the Grim Reaper.”
My professor replied, also sullenly: “We all are.”
Outside, I thought hard of the patient’s comment. My professor pointed to a small gray-scale picture of a man on a photocopy of a newsletter: “Do you know who that is?”
I had no clue.
“That’s exactly my point,” he continued. “He was our chief, a great man. He died some years ago.” He paused.
“That’s how it is. You go through life then you die. Maybe some people will remember you; the young don’t even know who you are.”
This was the first time that an attending physician had broached the topic of death with me, one seemingly so fundamental (rather than antithetical) to the profession of medicine. Indeed, delaying or easing death’s coming is so much of what medicine does.
When asked what I am learning in medical school, I always highlight the chronic awareness of mortality. Although I’ve grown in my understanding of medicine’s many marvels, I’ve also grown in my cognizance of human frailty. A blood clot much smaller than a pea could end a life.
This awareness of death has not launched me into existential stupor. In contrast, it has galvanized in me a strong drive to live. Patients who have gone deaf have taught me to listen to music with much more acuity. Patients who have lost the ability to walk give me strength to brave the next mile despite the cold Boston rain.
It is clear to me that the day-to-day is more key than professional publication or professorship at the end of the road. Call it a certain urgency to live, one that makes it easier, indeed imperative, to shed a grudge, to be kind. To tell the people I love that I love them, before I no longer can.
I asked my professor how this fatalism influences his life.
“I learned to not take myself too seriously,” he counseled. “Don’t worry about petty things. In the end, one’s whole life is petty. Therefore, you have to enjoy life.”
Fundamentally, I agreed with him.
Although the development of hospice and palliative medicine indicates that medicine more broadly can accept death as part of its purview, in medical school, death’s meaning beyond it being a break in life’s biological processes is rarely discussed.
We operate as if, as healthcare professionals, we can stave off death forever. When one treatment fails, we reach for another. When a patient dies, his name simply falls off the team census, drifting away like browning leaves.
In avoiding the material of death, we miss out on some of the most intimate lessons our patients can share.
It’s key that this conversation is opened, as my professor did for me. We in medicine are granted privileged awareness of the various, sometimes terrifying, ways that death comes to us all.
Yet death often happens behind a veneer of crisp white hospital sheets, shielding even those most physically close to it from its sights and sounds. And more critically, shielding us from its implications for the living.
The poet Rainer Maria Rilke wrote of death:
We know nothing of this going hence
That so excludes us. We have no grounds
For showing Death amazement and love
Or hatred, since it wears the age-old mask
Of tragedy that hopelessly contorts it.
We cannot rid death of its tragedy, and owe it to our patients to carry even a bit of that weight with them. Yet perhaps we owe it to the dying to behold death with amazement, arguably even love, for how it teaches us to live the rest of our days.
* * *
Edward Christopher Dee, 26, is a third year medical student at Harvard Medical School.
