We don’t play God

Details have been altered to protect patient identities.“’Tay, ’di ba sabi mo lalaban ka? ’Di ba sabi mo gagaling tayo?”

I press the phone even closer to my patient’s ear. His family was on the other line, in a quarantine facility far from Manila. They had all tested positive for COVID-19, but Tatay got hit the hardest. He needed intubation, dialysis, and a slew of drugs all intended to save him. But despite our best efforts, he was dying, and this was the only way his family got to say goodbye. Tatay died a few hours after that call.

Tatay was not the first death I’ve encountered. I’ve had several mortalities before and after Tatay’s death. Even before the pandemic, dealing with death was always part of the job. You’d think it gets better somehow, that maybe the next wouldn’t hurt as much or that the words would get easier to say. But no, it doesn’t. Maybe you get to be less confused or you get to learn from some mistakes, but death finds its way to break you, every single time. And with COVID-19 robbing families of their final goodbyes, death only hurts even more.

I used to think the worst part of patients’ deaths was when you declare them expired, as if this was when medicine officially lost its battle with death. But the worst part actually comes some time before that—when the patient is obviously dying, with very little we can do to save them. You learn to recognize this, in time, more or less knowing how far medicine can still go. It’s at this point when we often speak to the families and apprise them of the prognosis. We have more or less the same script: how we did everything we could, how further resuscitative efforts would be futile, how they can choose whether or not to proceed with the interventions. Then we hand them an advanced directive form to fill out and sign. On their end, the doctor is basically telling them two horrible things: 1) their loved one is dying, and 2) they need to decide whether or not to let go. The process is meant to help the family handle end-of-life issues and to give the patient a dignified death. Given the tremendous shock and devastation at the time, however, I wonder, in those few minutes, can they really make an informed choice? How do we expect them to decide through all that pain and grief? How can you ever expect anyone to think straight when their loved one is dying? What do you say when they ask, “Pa’no naman po kami magdedesisyon, doc? Kung kayo po ba, anong pipiliin niyo?”

They say that doctors play God in those moments, as if giving the final say on who lives and who dies. But if I’m supposed to be playing God, then why do I feel so powerless? It’s just me admitting, to the patient’s family and to myself, that there is nothing more I can do. The helplessness is nothing at all like how I imagined doctors would feel.

When we dream of being doctors, we focus so much on the glamour of saving lives, but I wonder if we’ve ever realized how many lives we were going to lose, too. That’s a part we were never taught to imagine—the part where we mess up and fail, over and over. A patient’s death is not always a physician’s failure, but as we try to revive our patients in vain, it still feels that way. Even when the death is largely beyond our control, I always find a reason to blame myself, or if anything at all, I think that had someone else been on duty, this might not have happened.

Sometimes, I accidentally bring home mementos of these mortalities: advanced directive forms, CT scan requests, blood donor slips — utterly useless now that the patients are gone. Whenever I see these little reminders, I breathe a heavy sigh and think, “Sorry, I couldn’t save you.”

And after that, you carry on once more, because there will always be another patient that needs saving. You barely have time to grieve or process your own emotions; you are simply asked to pick yourself up and carry on. They say the best way to deal with these deaths is to learn from our mistakes, see how we could do better for our next patients. This is what mortality reviews are for — the painstaking process of going through each story and finding out what you did wrong and how you could do better. Lessons can be learned, for sure, but I’d be lying if I said these deaths didn’t scar me, wounds renewed with every death. It shakes us in ways PowerPoint slides and reports could never capture.

I don’t know how or why we continue to do this. I don’t know how we manage to carry on despite the pain and emptiness. I only find solace in the fact that, indeed, we carry on anyway. Perhaps it’s because we have no other choice, because the clock does not necessarily stop for us, because there will always be another patient that will need our help. So we see the next patient, we diagnose their illness, and we treat them the best way we know how to. Our persistence will never guarantee our success, but the true miracle, I realize, is not in the patients we continue to save. The true, understated miracle is that, despite the patients we lose, despite the uncertainty and helplessness, we choose to carry on anyway.

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Ella Mae Inoferio Masamayor, 29, is an Internal Medicine graduate from a government hospital.

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