Wednesday, 27 July 2011

Last breath

I have the day off. Now that is a big deal for me. I don't have a lot of days off. And I love it. I plan to do it more often. I have been to the gym and had my butt kicked by my personal trainer, I have had coffee, I have eaten gorgeous toast with vegemite and cheese, and cuddled the cat, played with her and fed her treats. (Apart from all the usual getting kids to school stuff).
And I have loved it all. It's only 10 am, and already I am inspired to write. This is going well!!!
One of my patients died yesterday. It all happened very quickly. She had been unwell for a couple of days and I knew she was dying after my assessment. She died within my 5 hour shift.
I had to go in and certify her life extinct. It was sad, but familiar. And it got me thinking about death, not in a bad way, but my experience of death, both personally and as a doctor.
My first experience of death was in the dark, dank and stinky dissecting room in medical school. I was 17, and had never seen a dead person before. I was petrified.
We walked in as a group. It was cold, and the smell was the most unusual plastic smell. One I had never smelt before, and one I will never forget.
The bodies were lined up in metal trolleys, and covered in linen. All the bodies were de-personalised: their heads were shaved, and it was very difficult even telling their sex, until you looked in the obvious places. I must say I became quite used to the idea of using these bodies to learn. Once their skin was off, they were simply anatomical specimens. I never attended the dissections of the head and neck, because I could not bring myself to stare at these people's faces, I did not wish to know that I was cutting into a human being, having to look at their dead eyes. And I guess that was my lack of understanding, my lack of experience. Our culture naturally avoids that.
Then, as an intern, it was our job to certify that a person has died. The signs need to be looked for: pupils are fixed and dilated, no breath sounds or heart sounds, no response to pain.
So, at 23 years of age, naïve and silly, I had to walk into a room full of mourning relatives, and poke a dead person and listen to their chest and shine a torch into their eyes. It was terrifying. And even more terrifying was the dead person who had already been placed into a body bag, and you had to go in, and go through the motions in the middle of the night, in the dark BY YOURSELF. I was so scared, I used to do things as quickly as I could and run away as fast as I could. I guess it was natural at the time, but now, my attitude is so much different.
I have seen a lot of people die and experienced my own father's death. I have counselled people who have miscarried, had a foetal death, lost a newborn, lost a child, I have seen dead children, mothers, fathers, grandparents. I have done CPR and fought alongside people to allow them to remain alive for as long as possible. I have watched my beloved pets die, and buried many of them. I have grieved, hard, and painfully; deeply.
I have cried when children die at work, when my long term GP patients have passed on, and accidental deaths are the hardest, the violent and unpredictable.
So how did I view this death? I was sad. She was a lovely little old lady. She told me she didn't feel very well, and slipped away comfortably. I felt compassion and care, I wanted to allow her to pass without discomfort. And as I certified her life extinct, I said goodbye to this vessel. I imagined what her hands had done, touched, created. I imagined those who she had loved and those who loved her, and I was glad to have been part of her life. I have accepted that this is something we all have to do: our final experience, the last one we will all have, and never have the chance to discuss with the living. In a way, I can't wait to experience it, like all other life experiences.
Of course I hope it is not premature, and therefore fight daily to keep this vessel as healthy as possible. Death is never easy for anyone, but for us, who face it daily in our working lives, it is just a part of living. So, I hope when my day comes, I face it as bravely as my patient did. And have just a caring a doctor, nurse, volunteer, family member, to hold my hand and whisper that is will all be alright.
In the meantime, I will try my best to make my life extraordinary. Starting right now! Have a great day!!!!

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