As doctors, we carry our dead with us no more or less than anyone else; it is only that we generally have many more to carry.
I can still bring to mind the faces of every patient I’ve lost. Some of them I remember only as faces and stories, or mainly stories, the names long since faded. The older or very ill men and women for whom I led resuscitation attempts for no other reason than that I was the closest doctor to their hospital room when their heart stopped beating, the children and infants I continued efforts for in the emergency room, who had died in the field but compassion dictated we exhaust every possible option for, and talk with the parents carefully and in person, before discontinuing our final attempts to bring them back. These people, created in the Image of God and bearing their own unique identity and personality I never knew, stay with me as memories of the last desperate battle against death, difficult decisions made rapidly, and finally small, quiet prayers offered in the unofficial office of priest I unknowingly accepted when I enrolled in medical school all those years ago. The memory of who they were in life is left in the safe keeping of others.
Others I had a greater privilege of really knowing; I was there not merely in their last moments but for their last weeks or days, saw them battle with and often come to peace with the drawing near of their time on this planet; saw them experience and then cease experiencing pain, anxiety, worry, doubt. Like anyone who has lost somebody, I have been struck by the strangeness of spending those days with them in conversation, earnestly offering what comfort I could, only to be in the room with them bodily again sometime later, but now utterly alone. I hold these images together, the person living and the person dead; but am thankful the former is by far the stronger impression. I have been thankful, when medical circumstances have allowed, when those last days have resulted in choices that led a person to die in relative peace and comfort at home or otherwise surrounded by loved ones, and my role of final comforter in life and companion on the very brink of death has been taken by others infinitely more qualified. In those cases, I have the privilege of keeping only the living person in my memory.
Still others I remember in three dimensions; their face and voice in life, their sense of humor, their struggles and triumphs. Those whom I have been physician to over many months and years and, like the patient I called ‘mi abuela’ and who used to slap me on the arm for being such a bad grandson, only learned of their deaths after the fact. Often those relationships went far deeper than the mere clinical as over time a very human fellowship came to define our patient-doctor relationship as much as any exchange of medical information, advice, or prescriptive guidance. These patients especially kindle in me the hope of Heaven, and I find unspeakable comfort and joy in the not unreasonable hope of a continuance of the friendship and brotherhood between two souls we began on this earth, then unalloyed by any thought of medical knowledge or clinical skill needed or offered.
We cannot recall all of these many losses with complete satisfaction. Often times we do reflect on our role in informing and preparing a patient for death with some degree of contentment, with the assurance that we had the needed foresight and skill for the moment and can take comfort, at least in our small part, in a job well done. In contrast, there are for each and every one of us mistakes we know we made, and hopefully have apologized for, that accurately place on us some small or large degree of responsibility for a person’s death. I am grateful that these experiences have been rare, and am deeply grateful to have found compassion and understanding at the close of each of those stories.
But most often, neither of these is the case; neither perfect complacency nor right and accurate self denouncement, and we are left with less closure, less complete understanding than we would have wished. For every tragedy where a family and friends are left to wonder “what could anyone have done?” there is a physician who is left to question, earnestly drawing on all their clinical reasoning and accumulated knowledge, “What could I have done?”
People think that as a profession, as a field of study, we engage in post-mortem examinations, case reviews, and mortality and morbidity conferences either because we long for greater academic knowledge or because we wish to find someone to blame for the tragedy of death. These are both true, though decidedly not in the way that most people think. The longing for knowledge is not sterile or disconnected from the human story or from grief, and the desire to assign responsibility is not adversarial or blaming, but rather both seek to view tragedy as an opportunity to grow and provide still better care in the future. In our anatomy classes our dead were our first teachers; ever after they remain our best teachers, because the lessons they provide are the most powerful. But there is a third motivation that I think is equally as powerful as the others. As physicians we carry our dead, and when a loss is unexpected or tragic, or holds any possibility of error (as almost all do), we carry the weight of the burden of that death all our lives. In seeking to understand the role we might have played we are attempting to define the dimensions of that burden; to know exactly how much of the weight we are, personally, to carry.
The Hope of Heaven is what remains. Similar to (I am certain) lawyers and social workers, physicians long for a day when our particular skills, abilities, and expertise are utterly and permanently irrelevant. The farmer or craftsman may contemplate eternity with an expectation of some continuation of a form of his earthly work, and hope to see it brought to completion by an increase and perfection of skill or else a diminution of toil; the doctor believes his work will be perfected only in eternal uselessness, when in the presence of the Great Physician we can have nothing at all to contribute. The most skilled physician on earth longs to be only a poor apprentice pruner or assistant herdsman in eternity, when pain, illness, and all forms of human, earthly suffering are at a final and unequivocal end.It is with this hope that we walk into every exam room, approach every hospital bed, and delve into every instance of physical, emotional, and spiritual pain. It is this hope alone that makes them bearable as a physician.
And it is this hope that we, implicitly or explicitly, hope to impart to our patients who are undeniably bearing the greatest part by far of those burdens, which with all our training we can only strive to lessen but know we can never truly undo or perfectly prevent.
Lord, hasten the day.