Friday, October 3, 2008

It's Not Personal. It's Business.

I had my first patient death today.

It's bugging me. Not for the reasons I think it bugs most people, though. There's just this general sense of "is that it?!" I feel a little bit gypped for him. Not least because he got me for his grand sendoff.

He was a patient I'd had before...a funny, friendly man who bore a strong resemblance to Rip Torn. He was a new amputee - not particularly life-threatening, but serious enough to make him somewhat of a regular in the hospital. My best guess is that he had a clot of some sort from the amputation, and it traveled to his heart. I had him two weeks ago. Last week he was gone, but apparently he came back this week to finally have that leg taken off.

In the short time I'd cared for him, I'd gotten to know some of his little likes and dislikes. I had no idea he was back, though, and when I heard the code blue called, I hadn't reported to the floor yet. When I got up there, I saw that the room everyone was packed into and gathered around was one that would probably end up being mine. I was still assuming it was someone I didn't know, though.

When you see a code blue being called on a TV medical drama, it looks like utter chaos. Everyone is frantic and yelling. This was nothing like that. There had to be 20 people crammed into his room, but it was so quiet that I could hear the CPR compressions being done from out in the hall. The room was so crowded I couldn't see who the patient was, but time of death was called not long after I arrived on the floor.

Sure enough, the room was one of mine. The aid that I was shadowing saw the charge nurse coming out and posting a sign on the door instructing that people see her before entering the room. The aid asked what had happened. The charge nurse seemed plenty puzzled herself, and mentioned that not an hour ago someone was bringing him a cup of coffee and he didn't seem to be in any sort of distress.

When she mentioned the coffee, I knew EXACTLY who it was, and she confirmed it for me when she talked about his amputation. So I was prepared when I went in with the aid to take care of him before his wife arrived.

I closed his eyes and helped change his gown and sheet. I smoothed his hair back a little. The tv was still on and I couldn't find the remote to turn it off (no doubt it had gotten shunted aside somewhere during the code), so I made do with turning the volume down all the way. And before I left the room, I couldn't resist making the Sign of the Cross over him. I'm pretty sure he wasn't Catholic, but I couldn't leave him without some gesture of dignity and care. Not after I'd just done what I did for him. His wife came in just as we were leaving, and she stayed until the funeral home came to get him. I helped move him onto the stretcher when they did.

For a moment, as he was being wheeled down the hall, I forgot his name. It suddenly became extremely important to me to remember it before they took him away, and fortunately I did, just before he went out of sight. I said a silent goodbye to him then.

It took me a while to understand what about all of this was causing a sense of disquiet. It wasn't the presence of death, or handling someone who was deceased. I'm not a squeamish person, and there was nothing gross or frightening about it at all. I'm not uncomfortable with death.

It wasn't that I had known him, or conversed with him, or laughed with him. There was no personal sadness or loss about what I felt.

I finally realized that this was exactly what the issue was - not that I had personal sadness over the loss of a patient, but partly the fact that I had none. It was just so impersonal.

Death is such an intimate thing. It leaves a person, or what was a person, so very vulnerable. Who was I to be the one to close his eyes for the last time? Who was I to be smoothing his hair and giving him a clean gown? I'm just some random student. I could have been anyone and no one. I had no business doing those things for this man. In doing them, I had a few rare moments of peace, but underneath that was a slight unease and a vague sense of wrongdoing, like I had just ducked under a velvet rope around a valuable artifact at a museum. An honor and a responsibility of that magnitude should not have fallen to me. He should have been cared for in that way by those he loved, not by an aid who didn't know his name and a student who struggled to remember it at the last moment. He deserved better.

We all deserve better. And so few of us get it.

I was expressing all of this to J. J, who makes the Sign of the Cross every time he passes a cemetery or a dead animal lying on the road, understood perfectly what I meant. He suggested that I go discuss what was going on in my head with our priest, and I think he's right about that. Our priest would definitely be of some help here. This won't be the last time I encounter death, certainly. It's not that I want to overcome this feeling, because the minute I do is the minute that I stop caring. It's also when I become someone who has no business in the medical profession at all.

What I need is a private ritual. A hurried, perfunctory little Sign of the Cross isn't enough. It's not adequate at all. I don't mean that I necessarily need to do anything more elaborate than that. There wouldn't likely be time, and it isn't my place to hold a full-blown funeral for each and every patient who dies, anyway. That would be every bit as presumptuous of me as taking care of this particular gentleman felt today. I mean more like something that is only reserved for that particular moment, when it comes along. Something I only do for a death, and at no other time. I just need a special thought, or prayer, or gesture, or combination of those three things that I can do to make it all a little less anonymous and disconnected. A little less like I'm trespassing on something sacred. Even if whatever that is only happens inside my own head.