I remember the first time I saw a man die. I was in high school, just eighteen, working as a hospital volunteer to escape some philosophy class I couldn’t stand. So this poor man, in his seventies, comes in to the E.R. by ambulance. The charge nurse gets report from the paramedics, looks over the chart, then comes over to me.
“Page the chaplain for me, would you Phil?” she asks, her voice doing its best to be detached.
It took him two hours to die. Prostate cancer. I sat at the monitor station and watched his heart, each time the P-wave flowed into the QRS complex, sharply spiking upward then back down again finishing with the T wave. Gradually, the QRS complex (the wave generated by contraction of the ventricles) got wider and wider, it began to resemble what medical professionals darkly call “tomb stones” or Ventricular Tachycardia.
The family was left in private for the last moments with their loved one but I could see through a small crack in the window what was happening. The man looked at his wife, took her hand, and said something she had to lean in close to hear, something shared only between she, he, and God. With that, he inhaled deeply, shut his eyes, and embarked to destinations unknown. There was an incredible peace to it. Something like waving from a ship setting off across the atlantic. It was that day, I think, my career in medicine started.
And so life progressed for the living. I graduated and went off to college with my heart set on being a doctor. I was mesmerized by the human body, its terrible fragility and its awesome resilience. If I were ever to need proof of the existence of God, I would find it there, in his master work of biology.
I still remember my first patient to die in my hands. To help my chances of medical school admissions, I became a paramedic when I was 19. That same year, in April, was my first cardiac arrest. You train and train and train for these patients so that you can instantly react. You switch into medical mode and the person is no longer a person but the test dummy from class that you simply perform tasks, often brutal, to illicit a response, nothing more. No heart, no mind, no personality, no soul. Just a slab of meat. That’s exactly what I did. I worked his code precisely like I was taught. No matter what drug I gave or how much electricity I pushed through his heart, still the monitor showed only a single, flat line. The man was “dead” far before my ambulance got on scene. He was found facedown in the drive way. The man went out to wash his car and suddenly his heart stopped beating and it was ugly. No warning. No preparation. Almost as if in a stroke of bad luck, his card was up.
I went to tell his wife the tried and true phrase, “we did everything we could. I’m sorry.” which, as it turns out, is never needed as the family reads everything in your eyes. You can read their eyes too. I’ve said that to many patients families since, mothers who have lost babies, sons who have lost parents, fathers who have lost their wives, and its always the same: they see in your eyes what you’re about to say you see their eyes beg you not to say it.
Death is always easier for us than it is for the families. We never allow ourselves to become personally involved with a critical patient. One must, none the less, have a strong philosophy on what it is to die. How to cope with it when people do. For some paramedics I know, they carry Holy Water with them to sprinkle a drop on the dead’s forehead as a prayer not just for the dead but for the living. One partner I had would always crank up Queen’s “Another One Bites the Dust” after a code. There are ways to help families deal with the loss of someone: you give them time alone, you page a priest, but always you say “they didn’t suffer”. Somehow, knowing how they died, we thought, would make the fact more palpable. That was our professional philosophy but no professional philosophy on dying prepares you for when it hits personally home.
Last year, one of my life-long friends fathers finally lost his battle with cancer. She was only eighteen when he died. I cannot in anyway fathom what that must have been like for her but for me there was a man who had been a staple of my growing up: he always wore his Bermuda shorts to church, he took our prom and school photos every year…and now, this man simply no longer was. He had become something else entirely. That’s where the philosophy comes in. What is it that we become? Do we re-incarnate? Do we live happily ever after in a Heaven? Do we simply cease to be? Michael Christopher said in his play The Shadow Box that “The trouble with dying is you only get to do it once.” It must be terrible frightening to stand upon the brink of a great unknown chasm knowing at any moment the shove will come from behind to send you into whatever it is that lies within.
My own father is in his eighties now, twice what Hannah’s father was when he died. I can remember coming home the first time from College after my dad was put on oxygen. This same man who sired me at age 60, this man who always seemed to me to be the robust sailor he always was in his youth, was now growing thinner, getting tired more easily, he looked weak. For the first time, my father was old. For the first time, I said to myself “My father is going to die.”
For the next year or so, I scrambled around thinking about all the time I was losing away from home, away from him, how I would never get that time back. It was like someone had slammed my face against an hourglass and all I could do was watch the grains of sand, so finite, fall through; all I could do was wait for the other shoe to drop.
In the fall of my Sophomore year of college, my father had a stroke. All I heard from my mother was he got dizzy in the shower, hit his head, and now was in the ER where I was started my health care career two years ago. All I could think was now it was the time, how much I had wasted, how much I missed my father, how much I wished I had told him that I loved him, how much I wanted to tell him how proud I am of him and everything he’s done with his life. I immediately left school and drove to Lubbock to be with him. Thankfully, the stroke was ischemic and he suffered no lasting damage. I still see patients, many much younger than him, who have been left vegetables by strokes and think just how lucky I am that he’s still alive.
And thats when it hit me. I finally realized what I believed about death, what happens when you’re gone; what happens when that shove comes and you plummet into the depths of the unknown. I realized then that it didn’t matter one iota. I became so obsessed with my father dying, with how sick he was or could be, I completely forgot about his living and more importantly the fact that he had lived. He’s currently compiling a collection of autobiographical items for me to read. What I know and believe now that I never would have thought before even given all my experience professionally with death is that when it finally does come, I won’t be quite as sad because of what my father was: to me, to his friends, to the people that loved him. I know I’ll look through all the things he compiled for me to read when the time comes to clean out his house and I’ll be able to smile. I’ll smile and thank God that we had the time we did and I’ll take comfort not in how he died but how he lived.
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