Sorry to start your Sunday morning with a morbid topic, but there you go.
I have been thinking about my experiences of death – indeed those of any doctor working in a hospital and those of people in general.
They are different worlds.
Last night I watched a little of ‘New Amsterdam’ with my son – this seems to be a modern-day version of ER.
The had a man haemorrhaging, operated via a thoracotomy – that is where they take a saw or cutters and open someone’s chest to get at the heart and lungs.
We talked about the operating theatre.
This stage even had observation windows that people could use to look-in; I remember they had one in Dundee when I was a medical student. I think I only visited once. Can’t remember what I saw.
And the thing is, the distance between this scene which is perhaps commonplace in America (what do I know…) and the reality of everyday life is stark.
Most people don’t get to witness such scenes and, nor do most people experience death.
Modern living has moved it out of the mainstream.
And yet, some of us, those doctors who are working at the extremes can encounter death on a daily basis. With this, I imagine, as with the superhero surgeon, the event loses some of its mystery.
It just becomes a thing.
A dichotomy, no more, no less.
Here today, gone tomorrow, to be flippant.
And yet, and yet, there is more.
It doesn’t just stop with ‘no breathing, no heart sounds, unresponsive,’ as we sometimes write when pronouncing death, not when there are people left behind.
Family, friends; son, daughter, husband, wife.
And this is the aspect of death that I find hardest.
You will have seen again on TV the situations where a doctor or nurse informs the relative, ‘I’m sorry, there was nothing we could do,’ and walks out. Sometimes the nurse remains back to offer comfort or support. Rarely the doctor hangs around.
And here, this is what I want to examine.
The doctor’s role.
At the point of death there is little more a doctor can offer; perhaps an explanation, beyond this it always seems like a platitude.
No more tests, medicines or treatments available, just the rest of your life without, Bobby, Catherine or…
And for the doctor, the man or woman in the hospital, this is often a great relief; they can move-on, become distracted by the next patient or challenge. The family and friends support themselves, sometimes the priest or chaplain.
Yet, should there be more, should there be an expansion of the role, or, is this just medicalising grief, in the same way that worry, fear, pain have been translated into ICD-10 disorders rather than existential states.
It is difficult for a doctor to change who they are – from a doer to a be-er.
I don’t know.
On the occasions when I have maintained contact with a family after the death of their relative, my patient, I have felt a significant strengthening of my purpose, value added to the meaning – I am no longer just a doctor, but their doctor whose intervention went beyond the offer of medicines.
Is this asking too much?
Is the disconnect adequate?
I don’t know. Every death is unique, just as with life or experience. My pain is my pain and it is as big or small as I perceive it to be; there is no room for comparison.
For now, I will carry on.