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Reflections: Time of Death

Christians believe there's a season to everything, and a time to every purpose under the heavens- a time to be born and a time to die. As doctors, all we ever want to do is to save lives regardless of time or seasons. We want to fix everyone. Because of what we do, someone's mum, dad, sibling, friend, and loved one gets a chance to go back to them. But what about the days when they don't go back; when you have to go to their families and give them a piece of information that may change their lives forever? What about those times when the body is so broken it cannot be fixed? No matter what we do, there are days when we can't bring them back. We have to call it. We have to let them go.

Often, when I record a patient's death time, I think about the loved ones they've left behind. I think about all the dreams that will remain unfulfilled. I often wonder if there was a chance that they'll survive if they lived in a more developed country with more resources. I think about the void that their death has left. Doctors are burdened with the responsibility of delivering news- both good and bad. We are being taught to empathize with patients and their families. And when that moment comes, and a patient dies, we must inform their families and loved ones in the best way possible, that they have lost the person they probably love the most. We must do all of this without getting too emotional or too personal. But doesn't empathy make the loss more personal?

I still remember losing my first patient less than a month into my first intern rotation. He was seven years old. He woke up a healthy boy, went outside to play, and was involved in a road traffic accident. He was only seven. His parents couldn't stop crying when they brought him in. He had very severe injuries; we couldn't save him. We attempted CPR, but we couldn't bring him back. We had to stop and call it. I kept wondering if (maybe, just maybe) we should continue. He is only a kid, I thought to myself. We shouldn't give up. It was the first time I had to certify a death. A few months down the line, I realised that the decisions that the job requires us to make were tougher than discontinuing CPR. I can vividly recall my very first experience with mass casualties during a night shift. So many critical patients were rushed to our hospital at the same time. Decisions and plans had to be made; who do we save? Who had more chances of survival to direct our limited resources? Whose family will I have to give heartbreaking news? None of these are easy.

Imagine parents never getting to see their kids grow up or graduate or get married or fall in love with kids of their own. Imagine the pain of a partner whose happily-ever-after ended abruptly or a child who will no longer hear their parent/guardian's voice. Imagine the pain and agony on their faces when you have to stand in front of them and say the words they dread the most. I often think about how broken they will be, and it makes me wonder if there will ever come a day when my heart wouldn't sink, telling friends and families that their loved ones passed away. I have to stand there every time and watch the light go out from their eyes. This remains one of the hardest parts of the job for me. They say you get used to it but four years on the job, and I am nowhere close to getting used to human tragedy. No matter how well-composed I am or how much I prepare myself, there are no right words for the families.

My sister passed away in a hospital five years ago. I sat on the visitor's chair in the ward and watched her breathe her last. The doctor and nurses barely spoke to me, and when they did, one of them told me I was going to be a doctor soon, so I shouldn't cry so much. But that was my sister lying there breathless. That wasn't 'just a patient.' I still don't get her choice of words, but now I understand why they barely said anything. There is nothing they could have said to make me feel better. Sometimes, there are no right words to make the pain less real. Most of the time, all I can do is sit with the families and loved ones while they try to process the unimaginable loss they have suffered.

Many clinicians hardly ever speak about the emotional toll of losing patients. Dealing with physical and emotional pain comes with the job. Every time a patient dies, it almost feels like we failed them. But I've learned that death, even though painful, doesn't mean failure. It means we did all we could, and it was time. If we could, we'll save everyone. I am glad I still get emotional when thinking and dealing with the deaths of patients. It reminds me that I am human. It helps me appreciate life and death. Being numb to human tragedy can be a 'necessary' adaptation mechanism, but it can be dangerous for mental health. Every day we step out of the hospital, we find ways to cope and deal with the pain and suffering we've seen. Some days I get home, and all I want is a brief break from reality- to decompress. So, sometimes I watch my phone ring. That's not because I am a terrible person. I probably saw and dealt with so much sadness that I am mentally exhausted and cannot deal with anything else. I have come to understand that it's okay to feel, to grieve for a patient. It's okay to wish there was more I could do to save them. I process my emotions by talking to my colleagues and my support system outside of work. Talking about how I feel helps me cope and keep my composure- to be there for the family that lost a loved one and do the very best for the other patients I still have to attend. Because the reality is even when the light of one goes out, 'the carousel never stops turning.'

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