Time of Death
I.III.II
TIME OF DEATH
You know, having watched so much TV, read so many books, heard so many stories… I’d always thought I was kind of impervious to death. Like I’d already gotten used to it. It’s a natural part of life, no big deal. It wasn’t until I started working as a doctor that I actually began coming to terms with it.
We have trillions of cells in our bodies. Around 37 trillion of them, to be more precise. And in each individual cell there are thousands of biochemical pathways going on at any given moment. Mistakes happen all the time, and mistakes are fixed all the time. But when that doesn’t happen, when a mistake isn’t corrected, there are still tons of backup plans that kick in to make sure things don’t get out of control. A cell that goes haywire will either commit suicide or be killed by other surveillant cells that form part of the immune system.
Or at least that’s what’s supposed to happen. Cells go rogue all the time and usually it’s not a problem. But sometimes it is. Sometimes the little bastards manage to escape unscathed. Then… then they go on to replicate abhorrently. They grow and fester and spread and kill. That’s cancer in a nutshell. Thirty-seven trillion cells in one body – just one to bring it to its demise.
When my father died, this helped me make some sense of it. You see, my father was human. He too had trillions of cells in his body. And it was one of the millions of cells that make up the parotid gland that screwed him over. And so, he was no exception. Turns out, just because he’s my father and I’m the protagonist in this story, it didn’t exempt him from the same fate that befalls the fathers of secondary characters.
Or maybe, just maybe it’s precisely because I’m the main character that this happened to him, huh? It had to happen for me to add some gravitas and some depth to my character. Right?
Humour aside, using that logic, it was relatively easy for me to deal with his loss. I mean, sure, he was my father, my dad, someone I cared about and came to love dearly, but it didn’t really wreck me with grief. It didn’t destroy me or have me wondering, “Why him? Why me?”.
People die, and he was a person just like any other. I dealt with it the way I thought I would. I went through the five stages of grief. I was in denial when I thought it wouldn’t affect me at all. I was angry when everyone flocked around me, projecting all their fears and insecurities about death. I bargained with the fact that his death had finally put an end to his pain at the cost of never seeing him again, which led into the depression phase. And then… acceptance – a stage you never really get over. And somehow, I dealt with it.
Then came many more deaths after that. My grandpa… man, I barely batted an eye when that happened, let alone wept in sorrow. The saddest part, the really worst part of his death, was the realisation that my past, my childhood, was slowly crumbling away – and the fact that I can be as cold and insensitive as they come at times. Seeing my uncle lean over the coffin and caress it whilst contorting his face into this horrid, tear-wrenched, second-hand-cringe-inducing mess was so over the top it almost made me barf in the middle of the service. I guess I owe it all to Izzie – my funeral giggles, that is.
Then there were the death of my beloved dog Kiba. As much as I had grieved my father’s loss, I can honestly say I never felt as much pain as I did when he passed over the Rainbow Bridge. What made it worse was that I didn’t get to say goodbye to him – given that I was fast asleep time. I would’ve gladly woken up, but my dear mother figured she’d put him to sleep and tell me all about it after I’d do so – given that I had to work the following day. Thanks, mum – feelings spared!
But anyways, my point, because yes, I do have one, is that whether it was friends or family, fictional or non-fictional, I was used to death. I mean, I’d even gotten over McDreamy’s death, for crying out loud!
But then… then I became a doctor. Then came all the patients who died under my care – the ones that were expected and the ones that weren’t. Death in hospital is so common, so ordinary, it practically loses its meaning entirely.
I’m not joking, sometimes it’s nothing more than an inconvenience. It’s that call you get at 3AM: “Actually, doc, you’ve got two cannulae, five bloods to take – oh, and bed six is complaining of chest pain. And don’t forget the guy who pasta-way.” Passed away. Past away. Pasta way. Hilarious. A phrase so commonly used it’s merged into one nonsensical word over time. That’s the extent of how desensitised to death everyone seems to be in hospital.
No matter how influential that person might have been. No matter the impact they must have had on other lives. The whole totality of their existence is now just a burden that falls onto the shoulders of a junior doctor. Yet another task to be checked off an already overflowing list. An entire life, now entirely inconsequential. Their story reduced to a minor detail.
June – a very successful lawyer, mother of three and wife to Jane – a pioneer in women’s rights, a trailblazer in her field and an inspiration to her fellow cancer patients. That very same person with such an inspirational story becomes nothing more than a sigh-inducing afterthought to a sleep-deprived doctor at 3AM. And it doesn’t even remain an afterthought for long. Soon enough, you’ll get another page: “Doc, you gotta hurry cause we need the bed!” And with one final grunt, you get off your ass, make your way to the ward, confirm they’re cold and yellow, report the time of death, and that’s it – “RIP” struck off the to-do list. Who the hell gives a crap about June now?
In hospital, I’ve noticed that death comes in two broad categories. There’s the menial kind – the ones for whom death is inevitable. The ones for whom death is relief from suffering. The ones for whom death is mercy. These are the easy ones for us. Especially if you’re on call and you certify someone you’ve never met. It’s an impersonal as it can get.
Then there are the ones that stick. The very few patients that haunt your dreams at night. The ones you’d come to know and care for. The ones who were more than just work. The ones who’d become part of your life. The ones who just… die. Unexpectedly. The ones who will torment you for the rest of your life. The ones who aren’t like the others. Not the ancient guy admitted just to pass away. Not the shrivelled old lady who’s DNR from day one. Not the middle-aged, cancer-riddled man for whom death is a blessing. The ones that haunt you are the ones who die despite your best efforts. The ones you feel you’ve failed. The ones who leave you wondering whether you could’ve done more. Whether you should’ve done more.
That “see you later” you never actually meant. All those “hang in there!”s that rang so hollow. The “we’re in this together”s. All the crap we tell them just to make ourselves feel better. Maybe it helps them – I sure as hell hope so – but it certainly doesn’t feel that way when you’re staring into their blank, unmoving eyes, blind hope trapped in those dilated pupils for posterity.
That’s exactly how it felt with this one guy. Mr Spaceman was a forty-year-old man admitted under our care with malnutrition secondary to a malabsorptive disorder.
He’d suffered from leukaemia at around ten years of age and had undergone irradiation and chemotherapy. Thankfully, he’d been in remission and living a relatively normal life since, but he was still burdened by the long-term side effects of his treatment. When he came to us, he was severely malnourished and had the stature of a child. We discovered he had a condition called protein losing enteropathy which prevented his gut from absorbing protein. We started him on total parenteral nutrition (TPN) – essentially feeding him through his veins. In just two weeks, he gained around five kilograms, more than he’d put on in years. He was doing so well.
Throughout his stay, we really got to know each other. He told me all about his job – he worked for a voluntary organisation helping people with substance abuse and handled everything related to printing. From hardware malfunctions to missing paper, from technical issues to anything else that could go wrong, he was your guy. He also told me about a colleague who shared my name and how much we had in common.
Every day, I’d see him on the ward round, then come back later just to check on him, make sure he was alright, maybe chat a bit. He’d been surrounded by friends and family his whole life and now found himself alone in a single-bedded hospital room. Many times, I’d walk in to find him blasting Boney M. at full volume. He’d turn the music down, invite me to sit beside him, and we’d talk. About NASA and space shuttles. About animals and plants. About his family. About how hard life can get, and how important it is to keep smiling through it all. I considered him more a friend than a patient, and I could tell he felt the same.
Things were looking up. He was in high spirits. He was doing so, so well. Until that one night. I arrived early the following day, loaded my patient list, and he wasn’t on it. I called the ward, thinking it must be a clerical error. They told me he’d died during the night. They’d attempted resuscitation for a full hour before calling time of death.
I was devastated. He was doing so well, and then… he just died. I couldn’t believe it. He just… died. I had no idea how to tell William and Dr Sugar. When I did, they were just as distraught as I was. Mr Spaceman, our forty-year-old friend… gone. I still remember Dr Sugar tearing up as she called his relatives. His father kept thanking us for everything we’d done. Meanwhile, I sat there feeling so damn useless and helpless, wishing I could’ve done something – anything – to save him.
And so I dedicate this space to the patients who’ve stuck with me – the same ones that add meaning to everything I do, the very same ones who inspire me to live my life to the fullest and without holding back…
To the forty-two-year-old woman diagnosed with ovarian cancer, whom we had to tell there was no chance of a cure and that her life on Earth would soon be over, leaving her children motherless.
To the man in his early fifties admitted for the first time with decompensated alcoholic liver disease, who never got the chance to make amends before he died.
To the sixty-seven-year-old sweetheart diagnosed and dead within two weeks, whom I’d told we were still in time to do something about her cancer.
To the wife of a patient dear to my heart, who used to call me their guardian angel before he passed away.
To the old man who practically returned from the dead despite what we’d told his loved ones, whom we’d had so much hope for, who died so unexpectedly.
To all these patients – and so many others – I dedicate my career. To those who inspired me to go above and beyond what’s required of me. To those who made me more human. I may not believe in heaven, but I sincerely hope you’ve all made it there. Thank you for the lessons you taught me.