The Dead and the Dying

Few things in life are certain, and that we all have to die is one. If, of course, you are reading this from the year 2242 and civilisation has figured out how to put consciousness into computers, please ignore that sentence. In medicine we come across a lot of suffering and death. I would like to share a story which really touched me and how I handled it.

I was on call during my surgical rotation at Bara. Nothing special, really. A couple of botched circumcisions, tender McBurney's points, gangrenous diabetic feet, etc. That's when a lady, we'll call her Patricia, came in. I looked at her file and it said "Abdominal swelling". That could be anything, I thought. I took her history and it was evident that she was the picture of health. In summary: Patricia was a 59 year old female with no chronic medical conditions who presented to us with a 6 week history of abdominal swelling. Examination revealed a large, firm, nodular, non tender hepatic mass. Nothing else.

"I'm so excited," she said, "in two weeks' time I turn 60 and get to retire. I look forward to resting and spending time with my children."

As time went by the diagnosis became even more apparent. Patricia had a diffuse hepatocellular carcinoma. Imaging revealed that the mass could not be excised. The prognosis? Very, very poor. How is this possible? Just a few days ago Patricia, with no discernible risk factors for liver disease, came in with a mass in her abdomen - now she's been given a death sentence?

Over the next few days I saw her deteriorate. She became terribly jaundiced, encephalopathic and delirious. Still though, just the other day she was O.K! She passed away exactly two weeks after being admitted. Two days before she passed away it was her birthday. I remembered. I bought her a small gift. She loved it.

This whole situation had me doubting why I was studying medicine. If Patricia had stayed home the outcome would have been exactly the same. We did her no good, whatsoever. Not because we were incompetent, but because of her disease. This hit me so hard. It was very tough. Then came the realisation - I made her smile and laugh and enjoy her birthday, her very last birthday. I prayed with her in her last moments and made her feel comfortable. That's what I could offer this wonderful lady.

Perhaps the biggest lesson learnt was that we aren't only here to save the lives of people, but also make their last moments tolerable, even enjoyable. Try to remember that... Her last words to me as she dipped in and out of delirium was, "You are a good doctor."... Words that I will never forget.

You will see a lot of sadness, pain, suffering and death. Find a way to deal with it. Speak to your colleagues about it, pray about it, cry about it. My favourite form of therapy is laughter. Often you have to laugh like you're insane to remain sane.