ARE YOU READY TO DIE?

I am a 4th year medical student and was posted at the orthopedics department of a public hospital located about 150 km away from Kuala Lumpur for learning. As a student, my job there was to learn through my patients. Patients are my books. You can learn so much about a disease by reading all the medical books in the world but, learning about a disease from a real life patient in front of you is what makes you a competent doctor in the future. No books can teach as well as a real life patient. Not everything you read in a book will exactly be manifested in a patient. A patient with the same disease that was described in a book can be present with mixture of so many signs and symptoms that can point out to various diseases. But to reach a final and correct diagnosis is so important and that’s why you need to learn through your patient. Being a competent and safe doctor is so important in order to save lives.  So, every morning, as a student, I get to the hospital and I head to my ward.  I take a look at the new patients whom were admitted the night before. We divide the patients among my friends and we clerk the patients and share the knowledge we gained from the clerking to each other. In case if you don’t know what clerking a patient mean, well, clerking is a comprehensive history and full examination of a patient taken when the patient is admitted to the hospital. This includes initial investigation results, the differential diagnoses and a management plan.

We follow the ward rounds carried by senior doctors and specialists in order to learn more on the management of the patient.  We also present the cases to our lecturers and senior doctor who work in the same ward and they share with us what they know about the patients. We share knowledge and we learn together. That’s how things work in the clinical years of medical school.

It was an ordinary day for me in the hospital. I reached there about 7.30am, headed to the café to get my usual morning coffee because I am addicted to it and my productivity level goes down the drain if I skip my coffee.  So, I walked to my ward while slowly sipping my coffee while my other hand carrying my Apley’s Orthopedics textbook while going through all my to-do-list of the day in my head.

Then I reached my ward and I put all my things aside and took out my clerking book from my back pack and headed to the ward’s white board to look at the list of patients whom were admitted the night before.  And then suddenly, I heard a group of nurses rushing to the bed of a patient, one them anxiously yelling, “Patient is not responding!’’. The patient was a middle aged Indian man. I think he was admitted the night before probably from the emergency department. His eyes were half open and he was not breathing. A nurse then came running with a crash cart to start the resuscitation. Then a few doctors rushed to the patient and started doing the CPR while the patient’s wife who was there earlier by her husband’s side overlooking everything that was going on very anxiously.

Well, for me, I was nervous as well as this was the third time I was seeing a person dying in front of me and how each and every medical personnel there was working their ass off to save his life. The last time I got to see a CPR was on my own father. He died due to heart attack 7 years ago and lost my mom to cancer 8 years ago. Death of my parents were the main reason I wanted go to med school in the first place, because I wanted to save lives. Well, I know this is a typical thing for a med student to say but for me I really did want to save life. Losing my loved ones and also seeing them being eaten away by the disease was my motivation to give the best for my patients. I admired the doctors who tried hard to save my parents.

But, that moment, I realized I will never get used to death.  I remember seeing the patient just moments ago. He was breathing normally. He was alive and he looked peaceful. Peacefully alive. But in a glimpse of a moment, he was gone. The situation in the ward was messy. Doctors taking turn to do CPR and nurses running around and getting things done for the doctors who are doing the resuscitation. I was secretly praying that he would start breathing again and that his pulse would come back. And my heart ached to see his wife crying and anxiously talking on phone, asking someone to get here as fast as they could. Probably her family. After trying for nearly an hour, I think, I wasn’t keeping track of the time, the doctors pronounced him dead.

The whole day passed by, and I couldn’t do anything that I was suppose to be doing on that day. When I was sipping my coffee this morning while walking to the ward, I didn’t know I was going to encounter an event that would affect me so much. I was lost. I just needed to be alone and I needed space to think. I asked God. Why? Why he has to die? I know everybody has to die someday, but I just didn’t think anybody deserved to die. Whose fault is it that he is dead now? Is it his fault? Is it his doctors fault? Or it is just God being so mean to take away his life? Its nobody’s fault. No one is to be blamed. Life is so fragile. Life is so short. A person that you see who was smiled at you by the hallway, might be dead the next moment. Death is waiting for us at every corner. But not everybody is lucky enough to escape it.

Life is really really short. You never know where you will be in a blink of an eye. You might be dead. You might be alive. I don’t know. But are you ready to die? What kind of person you want to be before you die? You want to be a good person or a bad person? How many people have you wronged before and you never said sorry. How many people who wronged you that you refuse to forgive and you are still keeping the grudge inside you?  When was the last time you called your mom and dad? When was the last time you actually spent a quality time with them? Maybe you had an argument with your spouse or your parents or your siblings and you left the house without saying goodbye. You never know what will happen to them or yourself. If death decides to take you or them, all will be left is regret. You will regret for not saying sorry or saying goodbye. For many people, death is scary. But for me, what kind of person I was before I died scares me.

 ‘Dead people receive more flowers than the living ones because regret is stronger than gratitude.’

-Anne Frank-

Then, I left the ward for a while. I could not stay there any longer. The sorrow was in the air and I just could not breath it anymore. For after about 15 minutes, I got myself together and went inside the ward again to finish clerking a patient I was clerking before. I walked pass the bed of the patient who just died and his bed curtains were closed. The nurses were probably preparing to take him to the mortuary. I wanted to look at his face before they take him away. So, I peeked into the curtain to look at him. His face was so peaceful. He was not in pain. He was not in agony. He was in peace. I hope so. The nurses, about 3 of them were changing him, while the other nurse was taking off all the equipments attached on him. Then, I noticed something that surprised me. The nurses were talking to him while they were changing him. Maybe it is something usual and maybe I am the one who is noticing it for the first time, I don’t know. They were saying things like ‘We are going to slowly take off your shirt now’. The other nurse who was taking the cannula off his hand said to him, ‘ I’m sorry. It’s going to be a little painful, but I will be really slow. Is that okay?’. Well, of course he didn’t answer her. He was dead. But I was really surprised me that they were talking to him. Well, I didn’t know what I should even feel about it. Like what should I feel about it?

Then, I finished clerking my patient. It was lunch hour. I had a delicious fish curry and rice at the café. I tired to put aside everything that had happened and enjoy my food. I then returned to the ward. I walked from bed to bed reading their files. Then this group of nurse whom were changing the patient earlier were at the corner of the last ward cubicle. The cubicle was empty. They were sitting on one of the empty bed and chatting. I was curious. So, I went to them and introduced myself and quickly got to the question that was burning in my head and the question that I was curious to know the answer. Well, they were trainee nurses. They were doing their practical there. And I asked them why were they talking to the patient who was already dead? Well, I knew the answer to the question. But I just decided to ask anyway. I just wanted to hear their perspective. Well, their answer was, “ We are taught that way ever since the first year of nursing school. We gotta treat them the same no matter they are dead or alive. We must treat them with respect as how we did when they were alive. The way we treat the dead is important not only to the medical profession but also to the society we live in. The way we treat the dead shows how much we appreciate the life itself. That’s what makes humans different. We are humane.  We treat people with dignity. We respect both their body and soul.’’

I was intrigued. As medical students, of course we were taught to respect our patients and stuff. But listening to what the nurses have said and watching them do it, it was beautiful and I immediately felt content. I realised one thing that moment. Being a doctor ain’t easy. It is one of the toughest job. I am gonna be super busy. I might have no life. I will have to work day and night. I might not have sleep. I might end up hating my job like most adult working society do. But, I don’t mind going through all this to put a smile on a person’s face, to cure and to take away the pain. It’s okay to come home super tired but with a smile on my face thinking that I saved someone today. It’s okay to work like hell to save lives. 😊