“This is the end, beautiful friend
This is the end, my only friend, the end
Of our elaborate plans, the end
Of everything that stands, the end.”
– The Doors
I am an obstetrician. My job, distilled to its essence is to be present and assist during the birthing of a new life. Labor has its inherent risks, but with credit to those who came before me, delivering a child has never been safer for most of the general populace. Having chosen this rare field of medicine that involves the happy beginnings of life, death and dying has not been part of my standard repertoire.
These days however, I find myself in unfamiliar territory. Having consciously chosen to further my training in the intensive care unit, I spend my hours helping patients fight battles that can rarely be won. It has been a curious transition, from hearing the newborn’s first cry on the labor ward to being privy to a person’s last few breaths in the ICU.
As a simple obstetrician, I felt unprepared for this new role. I had prided myself on my patient interactions and conveyance of comfort in difficult situations, but now I found myself with patients that could not speak, and for all practical purposes were barely present at all.
“Living” in the ICU, I have come to realize, is a numbers game. What we do here is make adjustments to your numbers so that they are at a level acceptable to life. Your body can’t regulate those numbers anymore, so we do it for you.
Death touches everything in the ICU, while paradoxically remaining a place full of life. The IV’s drip and the ventilators whir, the nurses juggle their mountain of tasks while protecting what little dignity the patient can have. The health care team rounds, making our little adjustments while the families struggle not knowing what comes next.
The patient’s come and go, but we the health care staff persist. The drugs and the machines and the incessant beeping remain the only things untouched.
This contrast of life intensifies for these patients in their final dying moments. When the code blue is called, doctors and nurses and respiratory therapists, drenched in adrenaline, their hearts pounding push on hearts that refuse to do so anymore. Despite all the marvels of modern medicine, the reaper remains the ultimate champion. Six billion years plus in the ring, and undefeated.
In totality, everything we do here is simply an attempt to prolong the allotted time you have been given, but what is it that we are allowing you to do with this new time? Many patients admitted to the ICU will never return home, and fewer still will be fully liberated from the machines and drips keeping them alive. The trauma of surviving the ICU has its own support groups. Why is it that we, at the grand finale of life, either by choice or by convention prolong the more tragic moments and prescribe medications to forget, when instead it should be a time of remembrance. Isn’t that the whole point of a life well lived?
It is easy to blame the health care system for this sorry tale of affairs, but we can only operate under the guiding light of public perception. Our society does not like talking about death, even though it is one of the few commonalities we inevitably share. Terms like “death panels” are thrown about, and the sticky ichor of politics invades what should be an important conversation. We rarely acknowledge our own mortality, yet this is a journey we will all make as passengers someday. It is important to understand that while we may not have control of when and how we end, we still may be able to choose some of the terms involved.
Do not get me wrong. I understand my naiveté about such matters. I am not close to my mortality yet, but I sense it as present somewhere on the horizon. The question of my mortality will become less theoretical and more practical as I edge closer to my end. My priorities might change. I may value the limited time that I gain from these superhuman maneuvers or may suffer them silently to give my family their moments of goodbye. But how is it possible to make these decisions without being confronted with them. How do we counsel patients and families to face this uncertain future? The best I could come up with is this: If we continue treating life as a race, one day soon we will find ourselves at the finish line and wonder why we chose to run to the end.
Ravi Chokshi is an obstetrician-gynecologist.
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