” There are stories that are true, in which each individual’s tale is unique and tragic, and the worst of the tragedy is that we have heard it before, and we cannot allow ourselves to feel it too deeply. We build a shell around it like an oyster dealing with a painful particle of grit, coating it with smooth pearl layers in order to cope. This is how we walk and talk and function, day in, day out, immune to others’ pain and loss. If it were to touch us, it would cripple us or make saints of us; but, for the most part, it does not touch us. We cannot allow it to.”— Neil Gaiman. American Gods.
On 18th April, 2013, for the first time since I started clinical rotations, a patient I was caring for died.
He was a young man, brought in from the rural interior. He had been sick for days and was unconscious when he came in. He was intubated and was undergoing stabilisation in the ER when he began to get cardiac arrests…within 24 hours of his admission, he passed away.
The last few minutes of his life, I was the one doing the CPR. I had to be pulled away when the time was up and he was declared dead. He was 31 years old.
There had been patients before whom I had taken care of, who had passed away, but they had been older, and I was never with them in their last moments. For a few hours after he was declared dead, I walked about in a stunned state. It was near the end of our ten-hour shift in the Emergency room, and my fellow students and I were exhausted, along with our attending and residents. It had been a long night. Two other patients had undergone cardiac arrests, but happily they were expected to live.
In the car on the way home, I finally found myself alone and began to slowly process what had happened. I felt again the man’s sternum under my hands, the frantic desperation of the CPR, the dull weariness that crept over me when it failed. I saw again his half-closed eyes, the bewildered faces of his brother and father outside while we were resuscitating him, the quiet, head-bowed acceptance when they were finally brought the news.
I thought of my own life – I was only a few years younger than him, and I felt as though I had barely begun to taste life. I thought of my dear soulmate, and I wondered if the poor man had left behind a grieving love of his own. I thought of my parents, my sick mother, my friends, the people I love and cherish and could not bear to lose, in such a manner, in any manner. The sheer unpredictable fragility of life seemed to hit me right in the face and I started crying, helplessly, painfully, while the desolate roads of Karachi at 7 am on a strike-day morning rushed past me. I cried and cried, all the way home, all the way into the house, all the way until I stumbled blindly into my mother’s arms and she told me to hush, that this was a part of life, a part of my job, and I couldn’t let it affect me this way.
When I recovered, it seemed easy to blame fatigue for the tears, because otherwise I barely knew the patient I was sobbing for. But the truth is, while I was crying for the man who died, I was also crying for myself, for the ones I loved, and how I couldn’t really save them either, not from pain nor suffering nor death, in the same way that I couldn’t save that poor young man. For all my knowledge and training, I and everyone around me was so frighteningly powerless in the face of circumstance and fate.
The truth of the matter is that life really isn’t fair. Though doctors take responsibility for people’s lives, so little is in anyone’s control and so much is meaningless chance that all we can do is try, and some of the time – most of the time – that’s not enough. I will never forget the man in the ER, or the incredible sense of powerlessness and sadness I felt that day, or the consciousness of the sheer instability and unfairness of life that came to me. I will never forget, but like the quote above, I will have to cover that sadness with layer after layer of covering, so that I can function, so that I can solder on and, essentially, live my life despite that knowledge. The sadness will live inside, and hopefully make me a better, wiser person, but I cannot allow it to affect me. I want neither to be a saint nor crippled.
See you guys soon.