Death: friend, foe, or something else?

The thing I think would surprise people the most is my relationship with death.

I’m a critical care anesthesiologist. It’s an exciting, rewarding field – I tell my medical students and residents that it blends expertise in the human body with mastery over crisis.

I started my career imagining every day in the ICU as another battle between the living and their eternal foe: death.  As the attending intensivist, I’d lead a team to snatch patients out of the swift currents of the River Styx and onto the shores of the Living, while Death screamed his frustration.  As I tuck more years of practice under my belt, I realize my relationship with death is not so easily defined. Yes, I put countless hours in at my patients’ bedsides, railing against Death with medicine and machine to beat back his relentless assault.  But I also have a curious companionship with him.  It’s a companionship that is born of hundreds of solemn meetings together, and the ultimate realization that Death always wins.

In many instances, I’ve wept for patients who were carried away too suddenly, too violently, too expertly by that old bastard. I agonize over the care we gave and wonder if I had only played a little more accurately, to borrow the chess term, we could have saved them.  In other cases, though, I’ve beckoned Death to the bedside – to gently lead away a soul whose battered body was beyond the aid of modern medicine. I see death approaching, hear the bell tolling, and realize the only role I can play is to smooth the way for a peaceful introduction. I don’t delight in Death’s victory, but I do feel relief and a sense of purpose in making that resignation a painless, dignified one.

On the flip side, I have rejoiced with patients and their families when we win. Death skulks away in defeat, and another patient walks out into the sunlight to live a new lifetime. But I’ve also ached when we wage the wrong battles.  Losing battles, that out of fear, or misunderstanding, or denial, or a number of inexpressible reasons we lock ourselves into with inevitable, tragic results.  Death’s bony fingers claw and pull with impossible strength, drawing out a torturous fight that leaves patients dead and families, nurses, physicians, and staff scarred and exhausted. I’ve pleaded with families to let their loved one go, explaining that the fight is surely lost and would leave in its wake ruined finances, relationships, and spirits. More and more often, it seems, “Fight on,” is what we hear, so fight on we must.

I can’t call Death an enemy, and he’s certainly no friend. I’m not willing to consider him a partner, but maybe “associate” gets a little closer?  Like someone you ride with on the bus every day, competing for the best seat, but often just sitting together. I wouldn’t dare shake hands with Death (uh, COVID-19, anyone?), but it’s easy to imagine ourselves bowing respectfully to each other – just before the bell rings and the referee calls, “Fight!”

Joseph Pawlowski is an anesthesiologist.

Image credit: Joseph Pawlowski

View 1 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories