The unlucky privilege of seeing someone’s last moments

sonder – noun. the realization that each random passerby is living a life as vivid and complex as your own.”
– from the “Dictionary of Obscure Sorrows,” a compendium of invented words written by John Koenig.

I followed the chaplain into the patient briefing room, not quite sure what to expect. The room was dimly lit. The overhead lights were off, and only one small lamp gave off a weak glow, with the furniture casting long shadows against the wall. Extra clothes were messily sprawled across the floor and chairs, along with some crumpled tissue papers. There were two men and two women crammed in the small room, huddled together, sniffling softly. They were in shock and devastated, seemingly staring off into the dark empty space that surrounded them. The decision had been made to remove their father from life support — he was going to die later that afternoon.

Over the next hour, we sat together with this family as they took turns reminiscing about their father. The youngest daughter, who looked to be about the same age as me, had just returned from visiting his room in the intensive care unit. As she fought back tears, she told the family that he had turned down his daily mouthwash. It was his favorite part about being in the ICU — he used to open his mouth wide in anticipation, and the family shared a bit of laughter in one of the few moments of comic relief that afternoon. But the fact that he was refusing it now was an ominous sign that perhaps he was losing his fight and will to live. And the family knew that, for the brief moment of nervous laughter was quickly doused by a blanket of sorrow with that very realization.

One of his sons, a short but muscular-looking middle-aged man, was also in tears. His gruff voice quavered as he shared that he was extremely nervous for what was to come. He had attended wakes and funerals before for his distant relatives who had passed away, and these were in and of themselves devastating for him. But he had never had anyone in his immediate family pass away, and he had never been at the bedside, never this up close and personal to death. Understandably, he was unsure how he was going to react, and that uncertainty made him uncomfortable. It was a moment of vulnerability and endearment that the family clearly appreciated.

Interspersed throughout their wistful discussions were moments of prolonged silence, punctuated by sniffles, tears and the occasional sob. They hugged each other. They held hands. They struggled to reconcile their decision to pull the plug with the agony of feeling like they had given up on their father. The chaplain offered words of encouragement and support. I sat there silently, just listening, unsure where to direct my gaze unless there was someone speaking and uncertain if I was even welcome. Thoughts raced through my head.

As physicians, we all want to be there for the medical victories. We want to be celebrated by patients’ loved ones, and thanked for our talents and expertise as we successfully perform a curative surgery or prescribe a miracle treatment that others hadn’t thought of. But what I want even more than that is to be there for patients and families during the “failures,” the times where we cannot successfully resuscitate a patient, or cannot reverse the course of their disease. For as awkward, uncomfortable, insignificant and helpless as I felt in that small, cramped briefing room, I wanted to be there. I wanted to lend my words, my touch and my presence to the grieving family. If welcomed and allowed, I wanted so badly to sit there for as long as I could to be with the family members at this trying time. This afternoon was truly an unfortunate privilege.

We were eventually interrupted by the nurse, alerting us that the priest had arrived at the patient’s bedside. We all filed out of the briefing room and made our way over to the patient’s ICU room, all of us, including me, in a daze. As we all encircled the patient, the priest led us through several prayers and rituals. “Through this holy anointing, may the Lord in his love and mercy help you with the grace of the Holy Spirit,” he said, as he anointed the patient’s forehead with his bare hands in the form of a cross. Each family member followed suit, as they cried, kissed and reached around the endotracheal tube and dialysis catheters to gently caress their father’s lifeless head. One of the sons walked over to the window sill and looked out at the gloomy, rainy spring day. I didn’t need to see his face to know that he was clearly in agony. We stepped out of the room to offer the family some privacy as the nurses and physicians prepared to enter the room to shut off the machines supporting this man’s life.

And just like that, I was thrust into the real world again. The previous two hours felt as if I had plunged into a whirlpool of sorrow and anguish, experiencing close up the torment that faced a family, threatening to rip it apart, yet simultaneously acting as the glue holding everyone together. Entering that dark room to be with the family and finishing up the anointment and prayers at the patient’s bedside felt surreal, like I had left one world and entered another. And just as quickly as I was sucked into the emotionally charged scene, I was thrown back out, regurgitated into the bright lights, incessant beeps and noisy chatter of the surrounding ICU floor. Nurses bustled by, doctors were engaged in discussions, janitors were mopping the floors, dieticians were delivering food orders — all were innocently oblivious to the heartache and grief behind those doors.

In hindsight, I’m pretty sure just earlier that afternoon I had unknowingly passed by the patient’s youngest daughter at the coffee stand. I recognized her for the characteristic athletic jacket she was wearing. I might have even noticed her red, teary eyes. But maybe not. For moments earlier, she was nearly invisible to me, faint, unfocused, and indistinct in the background. Just an “extra” in the story of my life, one in which I am the main character, the protagonist. Just a bystander, with her own life as vivid and complex as my own, bearing the accumulated weight of her own dreams and ambitions, friends and family, mistakes and worries, triumphs and tragedies. She was shouldering an unfathomable, incomprehensible and invisible burden that I would not have seen had I not had the unfortunate privilege of walking into that dimly lit room this afternoon. And thus, as I walked through the busy hallways of the hospital and made my way home, carried away in my own ever-unfolding story, I could not help but wonder about all the other characters passing by and their countless untold stories.

Michael Tien is a medical student. 

Image credit: Shutterstock.com

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