Monday, June 23, 2014
His eyes are the most haunting memory from that day. They were empty and lifeless, a stark and jarring contrast to the frantic surroundings. I stood in the corner watching the staff try in vain to resuscitate the man, desperately wanting to help but knowing I was useless to them. “Let him go,” said the attending physician, as he gently placed his hands on the shoulders of the young EMT performing the chest compressions.
It took a few seconds before the reality of the situation finally dawned on me. It was only my third shift into my month long ER summer elective at Victoria Hospital and I was already witnessing what I had naively hoped I would never see in person: human mortality. I stood silently, teeth clenched and white knuckled, trying hard not to show my emotions – the fear and exhilaration.
Coming into the elective, I already had in mind the type of experience that I wanted to have in the ER: a fast paced environment with a spectrum of human suffering from the fatally ill to the bumps and bruises. I knew that death was inevitable in such chaos, yet I was still caught off guard.
I replayed that moment mentally for days and weeks after but what really stuck in my mind was not the event itself, but the discussion that I had with my facilitator afterwards. He saw the wide-eyed expression on my face and he pulled me aside to make sure I was still mentally intact – my mind was reeling from the complexity of emotions I was experiencing. I asked my facilitator if and when seeing death would become easier or if seeing death would ever become easy? His answer baffled me, “It becomes easier when you realize that there are things worse than death.”
What is worse than death? It was hard for me to believe that there was such a thing that can be more painful and heart wrenching than death – an experience that cultures, religions, and civilizations have tried to define and console us to. It was, in my mind, the ultimate of human conditions – the unaltered part of humanity that is inherent and innate to all human beings; the one truth in which we must all face and are unable to escape from. Human finality: people have and still do try to develop the means to escape it, whether through religious ideology or medical development. It is a fear that binds us all together.
I believe that I found the answer during one of my later midnight shifts of my ER elective. The date and timing surrounding the incident is a blur to me but every detail of the incident itself is etched in my mind plainly. A patient was brought in to trauma and resuscitation via ambulance following a motor-vehicular accident. He had been thrown off of his motorcycle after trying to swerve out of the way of a car that had been driving on the wrong side of the road. He flew off of his motorcycle going 80km/hour and landed awkwardly on his back.
I was asked to take a history and do what physical exams I could on the patient and after much fumbling about on my part, it became apparent that he had no sensation on his lower extremities below the nipple line. Preliminary X-rays showed spinal damage. I was and still am a little hazy on the rest of the medical details given how I was only in first year of medical school. After the surgical consultation did their assessment, it became clear to everyone, including the patient, what the outcome would be: permanent paralysis.
I do not know what aspect saddened me more: the patient’s young age – the patient was young enough that I could see myself in his stead – or the crushing realization on his face that another person had dashed his dreams and future aspirations away in a single moment of stupidity. What brought me to tears in the end was his conversation with his brother who had rushed to see him. The patient and brother shared a tender moment of bonding and true familial love; tears were shed from them and myself. In a moment of depressed confession, the patient told his brother that he would have preferred to die than be left with this disability. I did not have a moment of epiphany like those so often seen in the movies or on TV. It took me a few days to realize that I had found the answer to that question that had befuddled me so much. What is worse than death? Suffering.
It makes sense to me now. Isn’t the certainty of death easier than the uncertainty of a life full of suffering? Wouldn’t one prefer to go to hell than wait in purgatory? Death is an end to suffering for many, is that not the reason why so many fight for physician assisted suicide? While many of us fear death, all of us fear pain and hardship even more.
During those two separate nights in the ER, I had a profound moment of clarity on the human condition. It is not death itself that we fear most but the moments before it: the rigours of disease, the pain, and the uncertainty of life. What physicians are fighting against is not death in itself, but the suffering, fear, and chaos that it brings. The certainty that death brings should comfort us against the ambiguity of suffering. I went back to my facilitator with my new insight on life and he offered me a nod and a smile, a small gesture to acknowledge the small, yet crucial step that I had taken on my winding journey into medicine.