[quote]Dandalex wrote:
Well, as it has been mentioned shock value tends to go down with time.
I would tend to say that it goes away for most in the medical field faster than you would expect. This would be especially true for people who are exposed to it on a regular basis. ER and ICU staff tend to be the most exposed within the hospital setting but death, expected and unexpected, is a frequent event within general hospitalized population.
Whether it is because we see so much of it or that we have a job to do and that thinking that the patient is a person, a human being which is going through something atrocious or life-threatening is too distracting or simply because most of the time that you are on-call you are so tired you do not feel anything beyond wanting to go back to lay down and sleep (which I never thought could happen before I experienced it). Interestingly, these -dying biological machines- I work on to save/bring back in the acute setting only really become -real people- when I meet their family either to discuss prognosis, cessation of treatment or death because at that point at that point the immediate life-threatening situation is either terminated (improving or death), stabilized or sufficiently advanced that discussion for continuation or cessation of treatment is acutely important.
It is funny are we are made. I remember the first cadaver I saw at 6yo (my dad has been a GP and coroner for as long as I can remember, so I have helped him around and the funeral crews who pick up the bodies before and during my medical training, I have done my share of picking up or un-hooking cadavers and doing physical exam on natural death scenes, suicide scenes, car accidents, removing millions of maggots and insects from putrefying cadavers and so forth). I remember the first person I saw die before me prior to medical training but after that I do not remember the first pronouncement of death I did as a doctor and I do not remember the first patient for which I ordered the cessation of cardiopulmonary resuscitation manoeuvres which are events you would think you would remember.
Children are always the hardest to get over I think. My mom tells me of night more then twenty years back when my father came home from a scene where four children and a teenager had burned to death because of a stupid kitchen fire. He came in, did not say a word to my mother and went in my room where I was sleeping and hugged me and fell asleep holding me.
A great many things are too easy to forget, too many memories fade away that should not. But other things stay engraved in your mind much longer than you would expect.
One event that still makes me fight back tears many years later is a discussion me and my attending had on a Friday afternoon with a terminally ill 22 year-old bone cancer patient (and her family) in near constant, difficult to control pain, which I saw, spoke to and examined everyday for a month on the ward, whose only wish was to go home in the end to be with her family and friends who had come from abroad to say goodbye so she could die at home, in a happy place, surrounded by loved ones.
She understood very well that the end was near but her family could not bear seeing her at home because she would start bleeding on and off and required frequent platelet transfusions (even though in the end they had become ineffective (she had developed antibodies) after so many transfusions) and her parents could not stand the notion of seeing here bleed at home and not being able to do anything about it.
I remember standing there as my attending was telling her that she was too sick to go home (so as to spare her the fact that her family could not stand seeing her at home). But I think she understood it or knew it anyway.
I was heartbroken and trying to remain stoic and professional in front of something I found unthinkable, I remember thinking: We are telling this young girl who has been so brave, so resilient, so selfless who spent the last months of her life in ever growing pain in a small, drab, dark hospital room, breathless because of ever accumulating water in her lungs, that she cannot go home again, that we are denying her her last simple wishes and that she will die in that same little dark hospital room. The look on her face as my attending spoke made it difficult for me to breathe.
I wanted to shout to her parents: -You can only die once. Once it is done, you cannot come back and do it right the next time. At least give her that…- But I could not say that. Who am I to tell parents who are seeing their child slowly dying that they should just suck it up when they know they cannot do it and know that they will regret this for the rest of their lives?
After we got out of the room I felt empty and numb. I finished the day in a dazed, absent state and when I got home I did not know what to do with myself. I walked around in my apartment for a few hours sitting down than getting up every so often, turning on and off the TV every few minutes, picking up the phone and putting it back down, feeling that I should tell someone, say something, but every time realizing that there was nothing to be said, that it would not change anything. Nothing felt right.
I did not sleep that night until the morning and could not do anything or feel anything until the next Monday. Luckily I was not on call that weekend but Monday came other people were sick.
She passed away a few weeks later in that dark little room, her parents by her side with pictures of her friends and family plastered all over.
She was not three years younger than me.
What can you say when you hear a young 32 year-old woman going into irreversible respiratory failure shouting with her last breaths: -I don t want to die. Mom, please, I don t want to die.-
As I write this I still experience that sadness and emptiness. It is not cathartic. There is no right answer to this. It just -is-.
Death, blood, gore and cadavers are things that were, they do not exist anymore but I think that disease and pain and observing a personâ??s loved ones seeing their lives being torn apart by the death of that person mark you very deeply and for a long time, for you see it, you experience it, you live it.
Helplessness before death and pain remains unbearable. You can work around it, postpone it, block it for a while but it remains there, unadulterated. At least it does for me.
AlexH.
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I was fine until I read this sentence:
What can you say when you hear a young 32 year-old woman going into irreversible respiratory failure shouting with her last breaths: -I don t want to die. Mom, please, I don t want to die.-