Source: www.corbisimages.com
There was a time when hospital were where you went to be born or die, with very little variation in between. Now there is a less clear distinction, but still the choices are limited. I had my postings in a hospital for three weeks in which I had my many firsts; first cardiopulmonary resuscitation (CPR), first autopsy and first death. I am young and perhaps naïve, with half the time feeling like I know nothing and not yet jaded to many of the aspects of clinical care, but I have to say that it was a brief yet an eye-opening experience, from shadowing doctors to extracting patients’ history to tipping off in the operating theatre (OT).
A green light from the orthopaedic surgeon and there I was in the OT, eager to observe a surgery. I must tell you that scrubs are the most comfortable thing to wear in the world. The operating theatre was rather small and packed with housemen and students. The only available space to stand was right at the back of a door which proved to be an unwise and embarrassing move later on. You know you have absolutely caught all the highly- focused surgeons’ attention when someone opens the door where you are standing at and you gloriously lose your balance, end on your knees followed by crashing sound of the steel wares that was right beside you. The surgeons were worried if I was queasy and quickly asked if I was okay. That just was not my day and no, I am not haemophobic which means, having a fear of blood. I probably turned a thousand shades of red but thank goodness for the invention of surgical masks concealing my identity.
I also got to observe and assist in an autopsy of an old man whom later we found out died of a heart attack. That was the first time I held the human organs. I had to take a step back and let it process. In my hands was someone’s entire life; a brain. The brains are such amazing organs. From start to finish, every memory, every emotion, every bodily control, was right there in my hands. The human body is the best work of art I have ever seen. All the colours are just marvelling; greens, yellows, pinks and purples, the size of the organs- both larger and smaller than my textbook-informed mind had imagined. All that theoretical anatomy knowledge finally made perfect sense.
At the emergency room, there was a code red – a 13 year old boy, cachexic and unconscious. The only detail we were aware of was that he has been bedridden for the past two months. I do not know if it felt like an instant, or forever, but I just watched in awe at the entire process; chest compressions for 30 minutes and defibrillation. The lines on the monitor went up and down. There was electrical activity, but no pulse. One of the doctors permitted us to perform the chest compressions. I took the chance. That was my very first time performing a CPR on a real patient. As I began, I looked into his vacant, lifeless eyes that were wide open, staring at the ceiling. That image will never leave my mind. Eyes are indeed the window to the soul. No words, be it written or spoken could have prepared for the actual experience. That adrenaline rush, that moment when the thinking stops, and the doing takes over and everyone has their role, knows it and executes it flawlessly feels amazing. I secretly was hoping that his pulse would bounce against my fingers.
I stopped after five rounds. Another person took over. I retreated to my space and continued watching. After 30 minutes of futility, they stopped giving CPR. He looked like a broken doll. There I was, standing right in front of the screen, watching the line going up and down. Once and for all, it strayed into a horizontal line. Death won, but death always wins; the ultimate spoiler alert. A body drained of life was right in front of me. I just witnessed my very first death!
They covered him and started working on the documentation. It seemed like the doctors were not as troubled as I was, laughing out to their inside jokes all along. Perhaps that was their way to ease the tension in the room. To them, it was just another night, another person. To me, that was someone’s child. A mother has just lost her child. I cannot imagine the pain of losing a child. I am not sure if the pain will ever go away. I pretended I was okay. I stopped on a corner and felt it rise in me like it was my own heart failing this time, backing fluids into my lungs, breaking my breath. At the back of our heads, we all knew he was going to die, and yet we all hoped that he would survive. He was not my patient to begin with, but that eventful night meant something. It was worse knowing that he still had his whole life ahead of him; a golden future and a limitless potential of a thirteen year old boy. Until today, it kills me not to know what he suffered from. It definitely woke me up to the fact that medicine can sometimes have a depressingly limited ability to alter the course of a person’s life.
As much as it aches me to experience this, it was a great privilege to bear witness to these moments; the final chapter of someone’s life. We can never stop the inevitable. I know that it seems unprofessional of me to allow myself to become so involved emotionally, but it would do both myself and my patients a great disservice to harden myself against the pain they can cause, because without opening myself to pain I cannot open myself to the beauty of the human condition. And to do so, would lessen me as a person and as a future doctor.
We, on the medical side, thrive in the presence of someone’s misery. I did not choose this path to get a front-row seat to other people’s tragedies. I did, after all, chose this knowing it would stack my inner shelves with a library of human tragicomedy. I did it because I knew the world was bleeding and so was I. Somewhere inside, I knew the only way to stop my own bleeding was to learn how to stop someone else’s.
Death always wins, but there is power in our tiniest moments, humanity in shedding petty concerns to make room for compassion. We witness, take part, heal. The work of healing in turn heals us and we begin again, laughing mournfully, and put pen to paper.
Death smiles because death always wins, so you can relax. When you know you will not win, it lets you focus on doing everything you can to try to win anyway, and really, that is all there is: the effort. It cleanses. It wards off the gathering demons of doubt. I used to wonder how doctors go home and sleep easy after bearing witness to so much pain, so much death. The answer is that they are not bearing witness. They are working. Not in the pay check sense, but in the sense of the effort.
It really has made me consider the concept of life and death. I cannot help but to wonder how all life starts and ends equally, but depending on what you do with that life changes its worth. This is our life and it is ending one minute at a time. On a long enough timeline, the survival rate for everyone drops to zero. It is too short to pretend that we do not have supernovas bursting in our retinas when you smile. A hundred years from now we will be a handful of dust, and that will be for real. Our existence on this earth will only be as good as we make it.
I most definitely will never forget my firsts in medical school!
As Virgil says: “Death twitches my ear.
“Live”, he says, “I am coming”. Life is too short.”
Junaidah Mubarak Ali is a third year medical student studying in the International Medical University (IMU).