I came in the morning and did my usual routine of retrieving my ward list and scanning the list for any new patients. There was one, a terminally ill patient. Someone who understood her situation and opted to go peacefully. I walked past her room quietly, throwing a glance in. The patient i saw had a face so gray, i thought she was already dead.
We visited her on our rounds. I introduced myself. She gave me a smile so warm, i was disoriented. People who are about to die should not look so…happy? She reached out with her hand; i did not offer mine. I did not want to touch her, but then i was appalled at my manners. I could not even hold her gaze. The usual questions i normally ask my patients remained frozen in my throat. Do you ask a dying patient how they feel, are they feeling better or what plans they have for the day?
Just as we were about to exit the room, i reached out and held her hand. She clasped my hand in a surprising grip and smiled at me again with an encouraging look. I could only muster a weak smile and could not wait to exit the room. My head was churning with emotions. A dying stranger was comforting me because of her impending death instead of the other way around. What logic was that?
Throughout the day, i would not enter her room. I usually smile, greet or stop for a small chat with my patients, but for some reason i could not muster the courage to talk to this lady. I do not know how to converse with a lady who has no more hopes and only a final destination to arrive at. What do we talk about? What can we talk about? Everything else would be so mundane and pale compared to where she is heading to.
The next morning, i glanced in her room. I thought a face could not get any grayer, and that expression must be a mask of impending death. I have never seen that look before. 15 minutes later, i was paged. My patient had moved on. I felt a jolt of shock hit me. That was not a mask i witnessed; that was death itself. I just did not recognize it when i saw it.
I was asked to pronounce her death.
I hesitated. The senior doctor saw the look on my face.
“This is your first dead patient?” she asked incredulously.
I nodded mutely.
Instantly her expression softened.
“I will accompany you into the room,” she said and i was very grateful for that.
I knew what had to be done, but i never had to go through the motions before. Hell, i only did one week of palliative care in my 5 years of medical school. Now i wonder how we managed not to learn more about palliative care when it actually dominates every aspect of medicine.
I was afraid. This lady was dead but she was not a corpse to me. A corpse did not look like that. A corpse is one i associate at crime scenes and funeral parlors, not one that still retained some sort of human resemblance. I was frightened that she would rouse at any minute and yell at me to get my frigging fingers off her.
I did the sternal rub, determined to elicit a response. The senior doctor had to gently tell me to move onto the next stage. I auscultated the chest – it was silent, yet i held my breath and my stethoscope, waiting to hear a sound, any sound. It was weird. Then i palpated for the carotid pulses, and i knew i will not find one, yet i held my fingers to her throat, waiting for one. It was all so surreal.
Then i lifted her eyelids to look at her pupils and that was when i knew she was dead. Not because her pupils were dilated but because the eyelids did not slid back in place. I gaped in shock.
“Close her eyes Spud,” the senior doctor said.
I did as i was told. I have never known the eyelids do not move automatically back in dead people. Clearly i know they will but somehow the dots did not connect.
Then i wrote the death report. I carelessly looked at my watch and recorded the time of entry. The ward clerk ambled over, peered over my shoulder, noted the time and said, “That shall be her time of death.”
I stared wordlessly at her. How can such an insignificant action to one be of so much value to another, especially when it is not accurate?
I hope i never have to do that again.