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First Year PA

The Secret of Death

Published December 17, 2013 9:56 AM by Harrison Reed
I'm too young for this. That's what everyone says-or at least thinks, the way their eyes track across my features, down to the name on my coat, then back to my face. It's OK. I tell myself that I can earn the respect automatically granted to someone with a few gray hairs. Besides, there's a difference between age and maturity and these days I don't feel young.

It's not that I'm jaded. Far from it. I still care about every patient that rolls into my unit and every family member that shuffles out of its doors. But I watched a man die on Thanksgiving Day. I wrapped my arm around his wife's shoulders-a woman my mother's age-while I switched off his life support and bid farewell to my innocent youth.

Don't feel bad. I know what I write can be a depressing but that's not what I want. Most days I don't even leave work sad. Because every time I see someone die I get a little closer to learning the secret of life.

I've already told you that, in the ICU, the scoreboard is rarely in our favor. I've shifted my goals away from "saving lives," though my mom still thinks that's my job. If it was, I wouldn't be very satisfied. People will die. I've decided to worry less about the existential question of "why" and focus on what I can control, the "how."

I think everyone has some idea in their head about how they would like to die. They might say "in my sleep;" that's always a popular answer. The lack of awareness brings comfort. Most people would choose "painless" and in modern medicine that's easy enough (though the application is often botched). But these answers are reflexive, generated by fear and aimed at avoiding the physically unpleasant.

The next response will be some variation of "surrounded by those I love." Children and grandchildren are often mentioned as well as the companionship of a long-wed spouse.  Ah, now they are starting to get it. These answers aren't offered impulsively for a sense of protection. They come to mind because they represent something else: a sense of accomplishment in life, a completion of purpose.

In a fantasy death, most people are 80 or 90 or even 100 years old. And from what I've seen, the older someone is, the more accepting they are of death. I don't think that the age itself is a comfort or that the number on your birth certificate matters. But even the most deliberate person figures 80 or 90 years is enough time to accomplish the things that matter.

But what about the others? What about the globetrotting businessman in his 60s or the 54-year-old mother of two college students or the 32-year-old who hasn't sent her first daughter off to kindergarten? Surely their greatest deathbed fears revolved around unfinished business. The same reason I had a lump in my throat when they passed.

Now you remember that this wasn't supposed to be a depressing blog and I promised some bigger lesson. Here it is: death will happen and there is no telling when. You can't be angry about death just like you can't be angry about gravity. There is no debate. So don't ask what we will do about death. The real question is: what will we do about life?

The daily brush with mortality has had a strange effect on me. It didn't make me sad or scared or even pessimistic. If anything, it produced the opposite effect. I've started to take a few more risks, have a little more fun. I spend a little more money and eat a little more dessert. I skip the gym on occasion for the opportunity to try something new. And if something scares me, I do it.

If you believe age matters, maybe I really am too young for all of this death. But I'm not afraid of it. I've seen it enough; we are old friends. The only thing I am truly afraid of is not having lived.

5 comments

Matt, I hope you didn't misinterpret my meaning. Like any other person, I fear pain and suffering and misery. I would like to avoid those as much as I can. And I respect death, I have seen its ultimate power. I just don't live in fear of it.

I think a real fool is the person who lives to avoid the one and only certainty in the world. But your wise man is free to disagree.

Amy, thank you, I'm glad you were able to relate. I hope that my patients see me initially as a clinician but remember me later as a human being.

Lillian, it's so great to hear from others who use writing as an outlet in our field. I can only imagine the amazing experiences you have had. Enjoy West Haven, my first critical care experience was at the VA hospital there.

Lydia, Thank you for reading and thank you even more for sharing your own experience. I hope you inspire younger nurses to adopt your compassionate views.

Harrison Reed December 23, 2013 12:17 PM

I loved your view on death. I have worked all my career in ICU,ER,and trauma. I have been a nurse a long time and death to me is a transition to a pain free world. My profound experience was caring for a AIDS patient during the early years of fear. Nurses were afraid to care for this population and do not know why I embraced it. We will call this patient Angel and I felt a sense of obligation to help him transition through the process of dying. No visitor ever came and family had forgotten him.On his last day I had the pleasure and honor to be his caregiver,family, and friend. I saw in his eyes the fear but I gently touch his forehead , and wispered in his ear "Its Ok Angel you can go now, I will stay with you.I  gave up my break and sat quietly holding his hand as he drifted away . Breathing was slow and a look of tranquility surface on his face.

As a one year nursing career ,Angel was a blessing for me to recognize the importance not fearing death and yes enjoy every day

"

LYDIA December 22, 2013 4:45 PM
MIAMI FL

I worked in the health care system for 59 years. I remember a young girl who died because of an illegal abortion years ago.  I did not pay much attention to the dying until 1 year ago which two brothers died three days apart. I became so depressed. Then I wrote about how I felt. I then took a course at Southern Connecticut State University on Death, Dying and Bereavement.  I learned a lot about the subject that helped me deal with the loss and my own pending demise.  I am now 81 years old and thankful for each day that I wake up.

Lillian, Internal Medicine - ANP, Retired December 21, 2013 3:49 PM
West Haven CT

After spending many years in critical care and emergency medicine I can truly relate to this blog.  Being around death does at time make us a little jaded to the event.  I have always felt as long as I can define it medically in my head I am ok.  We as health care providers need to let our patients and their families know that we are human as well and we do grieve like anyone else.  

Amy McLaughlin, Internal Medicine - ANP-BC, IU Arnett December 19, 2013 4:41 PM
Lafayette IN

Harrison,

A wise man once said," ONLY  a fool does not fear death" Not that you are a fool, your response is the defensive stance that most who are honored to share in this very private and emotional event.  It is not till you face this event yourself that you will KNOW how you will respond.  So don't be afraid to cry with your patient...your friend.  Don't worry about waking in the dark of night with a departed patient in your thoughts.

Age and longevity as a PA will soften this experience.  I only hope you will learn, as I have after 40 years, that it is a privilege to share in the experience of death of your patients because you can make a profoundly soften pain and suffering of their loved ones.

Matt Freitas FNP-C, PA-C

Matt Freitas, FP - FNP, primary Care December 17, 2013 2:53 PM
modesto CA

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