death, again

Last year I wrote about my first patients I couldn’t save. It’s come back again this year.

There are older people who have lived content lives and are happy, who pass away in their sleep. Or at least that’s what I’ve seen in the movies.

What I see is typically younger people in agonizing pain, perhaps only made better because they’re so brain damaged from trauma that they can’t feel anything anymore (depending on your definition of “feel”). Blood and csf leaking out of their ears. Bones shattered like a dry stick thrown against a boulder. Body parts twisted in perverse ways constricting the blood and nerves.

Sometimes we can save people from the precipice and I have to tell you: it’s a pretty great feeling. Knowing that my team was the thing that changed the arc of events, that we kicked the grim reaper in the nuts, is a roller coaster of emotion but one that leaves you ultimately satisfied. Traumatized, sure. But satisfied.

But sometimes we can’t save people. Sometimes we have to shut down bleeds with our hands. We need to breathe for people for hours. We need to push down on their chest, manually activated the valve structures in the heart to push oxygen rich blood into their brain. We need to extricate our fellow humans from dangerous things and with steady hands pull them from the edge. But that despite all of that, they’re going to die very shortly. We have to hug them knowing that we, some random schmoe, is the last person they will see and the last voice they’ll ever hear.

It’s always particularly terrible to me that I know someone died before their family does. Somewhere there is a living room with people going about their lives unaware that a process has been put in motion to identify them as next of kin and give them a phone call that will alter their lives forever.

When I’m with a dying person in a lonely place I wonder if their family and friends are ready for that. Unfilled promises, dreams left open, and words never spoken. Disagreements and ego that seem so important until dwarfed by our own mortality.

There are people who study death and dying with substantially more insight than myself. Hell, there are people who don’t study these subjects who still have more value than me to share. The way you view it, and your experiences with death, will be different from mine. If my advice is worth anything to you, I only ask of you this simple thing. Every day (as best you can) show your friends and family that you love them.

Dying on an austere mountain side rips away all pretence and posturing. The indifference of our world and the limits of our own mortality are laid bare, connected to each other. It is in this exposed and raw moment that we can look at the love in our life and the hopeful futures of others we cherish. Our time has come to a close, and others now continue. Your connection to those others and their connections to you will be the last things thought in your mind.

I think it’s fair and somewhat expected to not achieve everything we want in our lives. Not everyone can be an astronaut, etc. But it is entirely in our power to genuinely care for others and to make sure they know we do.