Watching my grandfather pass away changed my life. It wasn’t sudden and it shouldn’t have been unexpected. Yet it seemed unnatural, mysterious, and incredibly uncomfortable. I can still remember receiving the phone call from the hospital, my mother letting out a distraught cry that my grandfather was no more. My initial reaction was shock and confusion: I just couldn’t understand what had happened. Looking back, he had been under intensive care for so long – five months to be exact – that we should have known that his body was only taking its natural course.
It now surprises me most that nowhere along the timeline from my grandfather’s early diagnosis of “heart and lung problems” to his death did a healthcare professional talk to my family about the reality of the situation. I’m sure the cultural barriers made it difficult, along with the intimidation factor of dealing a congregation of loved ones that paraded with him at any given moment. Still, my grandfather had two heart attacks, his lungs had completely collapsed, and he relied on artificial nutrition. He didn’t even look like the strong, independent person he truly was anymore. His entire body swollen, his face cringed in pain, and tears falling from his eyes every now and then.
All signs pointed towards an inevitable death, yet if you asked anyone in the family, he was doing great. He was recovering and would be out of the hospital sooner or later. In our hearts, we truly believed that he would survive his disease. The doctor didn’t tell us much, but he informed us that there was a chance – that was all we really needed. So the day he passed away, a deep-rooted immortal hope had died. My father immediately blamed himself for not trying hard enough. It is something that he has learned to live with, but I know the experience has been extremely traumatizing for us all. My grandfather’s death seemed unjust, cruel, painful, and (worst of all) unnecessarily prolonged.
This experience, being my first, I took as the definition of death. I found myself even more uncomfortable with the mortality of man than before my grandfather became terminally ill. As someone who wanted to become a physician, it solidified my belief that preventive and curative care was the best care. I would do the best I could, I would never give up, and I would never accept failure.
In fact, as silly as it sounds, I hadn’t really explored the thought of my future patients ever dying. The hectic nature of medical school barely gave me time to think of these things either. Caught up between gross anatomy labs and biochemistry lectures, I found myself dreading the times when we would have mandatory humanities classes, wanting to spend the time focusing on my study instead. This all changed one morning, when a guest speaker, Dr. Ira Byock, lectured the topic of dying. I expected to hear a somewhat mechanical approach – try your hardest to prolong life in the patient, be compassionate to the family, and fill out the appropriate paperwork after the patient passes away. After all, that’s how my grandfather died.
I remember walking away from that lecture fascinated. My entire life, I thought being a doctor meant prolonging life, yet here someone challenged that ideology. He proposed that dying is normal and wellness is not limited to quantity of life. This seemed absolutely bizarre. How could people feel well while they were dying? Wasn’t it a moment of struggle and defeat? My experiences clearly contradicted what I was being lectured, yet at the same time, what he was saying made complete sense.
At this point in my education, I find myself in a class focused on end-of-life care and under a mentorship exploring the topic outside of the classroom. It hasn’t changed my perspective towards providing the best preventive and curative care as necessary. But I do know that if and when I have a patient who reaches the end of life, I will know what to do. In such a trying and delicate situation, I will undertake a leadership role as the healthcare provider. I will actively educate and support the family in making the best decisions for their loved one. But most of all, I will ensure that the patient is cared for, well-informed, unafraid, and comfortable to the best of my ability in their last days. I have learned many new skills that I hope I never have to use. But if the time comes, I will be unafraid to reach out and facilitate the best care possible. Those moments, although difficult, I hope will become my most rewarding.
Since my grandfather’s passing, I have often thought back to him. In the beginning, I wondered more about the spiritual nature of his death. Now, I find myself thinking about who he was as a person, and how he would have liked to die. I wonder how his death would have affected my family as a whole if things had been different. But he was just one patient, in one bed, with one family, in one hospital.
What about the rest? There must be countless hospitals, with countless patients and families, dying in physical and emotional pain every day in this country. Though I may not be able to change the model of end-of-life care right now, I feel a little more comfortable knowing there is a shift towards cultural competency and exposure to palliative care in medical education. Doctors will be trained better in this arena and somewhere along the line, the hope is that the effects will trickle down so that patients and their families will come to realize that it is ok to die.
Shraddha Dalwadi is a medical student.