In every single person, there is a furious instinct to guard, preserve, and even trap life. In your final moments, we’re wanting to latch onto your life.
I was standing in the elevator when your daughter (presumably), and her husband walked in. I heard her quietly say that you looked like you were ready to go. She put her head on her husband’s chest and cried. She knew you were ready, and she didn’t want to keep you suffering. I have never met you and the odds were low that I would be in the elevator with your daughter on that day, but I have carried you with me since then.
The electronic medical record eerily allows for the play-by-play documentation of everything, including people’s final moments. From a desk in the emergency department, a desk in our office across the street, and even sometimes from my couch at home, I have read through this timeline. The electronic medical record can give a surprisingly good snapshot of someone’s life: married, divorced, a few children, miscarriage, history of polysubstance abuse, depression, anxiety, PTSD, glioblastoma s/p resection now new seizures, palliative care encounter, AICD placement, former smoker, newly diagnosed metastatic cancer, stubbed toe. There is also a lot to be learned from your medication list and trends in your lab work. Sometimes, I see this glimpse of who you are alongside active documentation of your resuscitation: epinephrine, calcium chloride, amiodarone, naloxone, bedside ultrasound, code end. Hiding behind a screen does very little to soften the blow of the time of death.
In the face of death, life has to move on. This is one of the most poignant and unnerving parts of grief. Frankly, it feels wrong. For loved ones, seemingly impossible. It is certainly challenging to do without an immense feeling of guilt. When I watch families leave their loved one’s room with a green bag filled with their belongings after saying their final goodbyes, I always expect the family to stop and turn around. There is a sense of finality leaving the hospital and then walking out into a world that hasn’t missed a beat. I have never seen a family turn around, but I have slowed my world for them and had a few more moments of silence.
I have met a handful of people who were not dangerously ill but nonetheless have left an enduring impression on me. I was standing in the hallway and asked a patient if she said something to me. She said she had not but then asked for a blanket. It was my pleasure. It turned out she had a lot to say. I sat in her room, and we talked until her provider came in. She told me to pick up her oxygen tank and stated that it probably weighed more than me. She said it’s exhausting to carry around with her, but that it’s her fault since she has smoked for years. She felt guilty, regretful, scared, and looked sad. When I left, she said, “thanks for listening.” I wondered if being listened to would be the most meaningful part of her care.
And for those who have committed suicide, I think about your pain often. It was harrowingly apparent that at that moment, you wanted your suffering to end. Your children found you, followed by your husband. They wanted you to stay. They wanted to save you. They desperately wanted to save you. You were close to making it, and I frequently wonder if that’s what you would have wanted. You lost your pulse in the ambulance bay. You were so close. There was an entire emergency department waiting for you. They were ready to save you. We weren’t ready to let you go.
Lastly, the people we have lost in isolation during the COVID-19 pandemic. Your providers are heartbroken. I know because I have seen them and I have talked to them. They’re upset at the way your care has to be delivered, that you have to be separated from your family, and that they can’t provide you with any certainty. Isolation and dependence on technology have made it difficult to maintain humanism in medicine, but it is there.
Before you go, you should know:
You are going to leave a lasting impact on those who have cared for you and those who have loved you. You and your family are going to be in the prayers of people you have probably never noticed. You’re going to motivate future physicians and nurses. Long after you go, you will stay with us.
Loved ones: You’re with us, too.
Nicole Russell is a premedical student.
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