In Between Two Worlds

Death is a part of what I do. Transplant surgeons take care of incredibly ill patients before and after their transplant. I like to say we win most of them, but we don't win them all. I am comfortable with death and I have been as long as I can remember. I do not take it as a personal defeat and I do not feel I can take all of the credit when someone does well. I do not mean I am comfortable with death in that I am unaffected by the death of a patient. I am deeply affected by the death of my patients and I am even more affected by the pain their families endure. I am comfortable with talking about end of life issues with families and I am comfortable in the role of being a healer in the non surgical sense. In fact, some of my best moments as a surgeon have been helping a family with the moments at the end of the life of their loved one. I learned a very valuable lesson about death and grieving when I was in college. I took an EMT course and worked in a hospital operating room while in college at UT to get some exposure to medicine. A very wise and seasoned paramedic instructor told the class, when discussing how to deal with the stress of being exposed to tragedy on a regular basis that the grief surrounding the tragedy we see belongs to the families of the patients and it is not our grief to steal. The statement "not our grief to steal" has stuck with me for over two decades now. She made it clear that empathy and sympathy for the families was acceptable and a normal process for caregivers, but the grief and the process of grieving belonged to the families. I believe this to be true. I cry with my patients in times of joy and in times of sorrow. It is part of who I am, and I can continue to do this job because even though I am at times sad, I know that I cannot and should not "grieve" for each patient we lose. There are others who need our care. All of this being said, even I can be rattled by death.

Last Saturday morning, I was awakened by a page at about 6 am. I called the ICU and I knew the phone call would be about Mrs. C. Mrs. C had a liver transplant about three months prior, but had been in the ICU and very sick for about a month now and it was clear she was not going to make it out of the ICU. I had been talking with her family for the prior two days and we knew her days were numbered, however, we had been treating her with the normal medications to keep her blood pressure stable until the family was comfortable with the decision to cease all resuscitative efforts. The family, especially her daughter and husband were obviously having a difficult time emotionally. I felt especially sad for her daughter who is close to my age and losing her mother. She is an only child. I was not so much surprised by what the ICU nurse said when I returned the page, "Dr. Anthony, this is Manu, I am calling about Mrs. C. She expired." (I had not been aware that one of my medicine colleagues had talked with the families late in the evening the night before and decided not to accelerate any care....so I actually expected to get some type of warning that her death was emiment....ie her blood pressure was low, heart rate falling) So, actually, I was startled by the call not so much by the fact that she had died but by the fact that I didn't get any warming as ideally I would have like to have arrived at the hospital and had her family come in and be with them when she passed.

I was particularly unnerved by the timing of Mrs. C's death because the page from the nurse woke me from a dream about her and her family. I have not had this experience before. I was having the dream during the exact hour she was dying and leaving this world for another. In my dream, the family was sitting in the family room at the hospital. They were seated at a long picnic table and there was food and laughter and they were reminiscing about the good parts of Mrs. C's life. I was seeing that moment in a family's grief when they are using good memories and laughter as a coping mechanism for some relief from their grief. We have all had these moments with our families when we have had a loved one pass. In my dream, I was comforted. I then went into the hospital room of Mrs. C and someone had taken out her breathing tube. She was talking (which is not possible when someone as sick as Mrs. C). In the dream, I knew this wouldn't last long because I know the real consequences of removing someone from life support. I quickly went to the family and asked them to go in and speak with her as she would not be able to do this much longer. In the next scene in my dream, she was laying peacefully in her hospital bed, then the beep, beep, beep of the pager.

I got out of bed, threw on some scrubs and drove into the hospital to pronounce her dead. I waited for her husband arrive. I did my best to console him. I talked to her daughter on the phone while Mr. C spent some time in the room with his wife. I told his daughter about my dream. I wasn't sure if it was the appropriate thing to do, but she said she was glad I told her. I also told her husband a little later. He said, "You have described exactly what we did last night after we left the hospital." He stated the family left the hospital the previous evening, after deciding not to continue to accelerate her, and went to dinner. He said the laughed and talked until midnight about good memories. I guess even if my conscious mind wasn't aware that she would be making the passage from this world to the next.....my unconscious mind was fully aware and knew I, too, needed some comforting about her impending death.

The names/initials have been changed for privacy reasons.