Endings

Growing up, every child has fears. Some are afraid of the dark. Others are afraid of spiders. Still others are afraid of the boogey man. My childhood phobia was death. I was a morbid little creature and the thought of “the other side” instilled in me an unrelenting terror as my head hit the pillow each night. Sometimes I would be able to distract myself until sleep came. Other times, the fear of death striking me, my parents, or sister would chase me into the safe haven of my mother’s arms.

The first time I pronounced a patient’s death was on my Oncology rotation. The patient was a morbidly obese woman in her 60s. She had had months of abdominal pain and bloating, decreased appetite, and vaginal bleeding. Unfortunately, her mistrust of doctors kept her away until she finally presented to Triage struggling to breathe. By the time she got to us, her body was found to be riddled with cancer. Within a week she was bed bound. She waxed and waned out of consciousness. The cancer had spread to her lungs (making every breath a struggle) and her bones (making every movement excruciating). I was working in the Oncology office when the nurse came to tell me she had passed. For a split second, my childhood fear of death made my stomach turn. Knowing she was going to pass soon, I had already been prepped by my senior resident on what to do to make her death “official”. But could I do it? I took a deep breath and walked into her room. When I saw her body, I knew immediately that she was dead. She look pale, gray, and waxy. I shook her gently while calling her name. I rubbed her sternum with my knuckles. No response to verbal or painful stimuli, I thought. I shined a flashlight into her eyes. Pupils are fixed and dilated, with no response to light. I grazed a piece of gauze across her eyeball and she did not blink. No corneal reflex. I placed my stethoscope on her chest and listened for a full minute. No heart or breath sounds, no chest rise. I looked up at the clock. “Time of death, 2:21pm” I heard myself say.

Being as über-sensitive as I am, I always imagined that my first death would leave me an emotional wreck. However, in this patient, it was the first time I had seen her at peace. It was the first time I had seen her lie still without struggling, wincing in pain, or gasping for breath. Now, after 2 Oncology rotations and 6 weeks in critical care, I see death in a completely different light. I’ve come to learn that there are such things that are worse than death. And for these patients, death carries with it a sense of peace and an end to suffering. My childhood fear disappeared that day.