Without support, the suffering associated with death could be overwhelming

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From Luke’s Journal 2021 | Dying & Palliative Care | Vol.26 No.2

I was surprised during my first few weeks of clinical placement at how infrequently I heard about people dying. I had a perception that hospitals were full of death, yet everyone seemed to be sent home in a better condition than when they arrived: death postponed for a little longer. 

Recently I completed a palliative care rotation and have had time to stop and reflect on how this exposure to many deaths during my clinical placements has affected me. Placing this in the context of holistic care, coupled with my Christian faith, has helped me to process these events.

As the years of my medical study progressed, encounters with those near the end of their life inevitably came, however not in the way I had previously imagined. I still have not been at the bedside of a person taking their last breath. Yet encounters with the dying have made their impact on me.

Of course, the first encounter with a dead body for many medical students is using cadavers for anatomy teaching. The caution and uncertainty of the first day in anatomy lab quickly turns to a respectful normalcy. Yet in this environment the personal story of the person who has donated their body is removed. We can learn about their medical conditions through our findings, while their personal stories remain a mystery.

During clinical rotations, this scenario is reversed. Now, the story is more clearly known. I have had conversations about hobbies or favourite movies and met with family and friends of many people who have since passed away. This reversal, not necessarily seeing the person after their death and yet knowing so much more about them personally, is disconcerting. 

My interactions with patients towards the end of their lives have manifested in many ways:

• I have experienced uncertainty and discomfort as a patient joked about being ready to die. 
• Curiosity about the palliative care room at the end of the hallway that the medical team seldom visited during ward rounds. 
• Frustration at the hospital politics and under-resourcing in the public system that left some rural patients stuck in a hospital that could not care for their needs rendering them unable to eat: a nasty physical reminder of the human cost of the bed pressure and under-resourcing in the healthcare system. 
• Respect and sadness for families journeying with their loved ones through a defining period of life. 
• Dismay at the inexorable course of a lady with ongoing complications after a complex surgery. 

As I have advanced through my clinical years, I have experienced the irrational hope and feelings of helplessness as I performed CPR in an emergency department on a child who was dead before the long ambulance ride that took them to hospital. My brief hope that spontaneous breathing resumed was dashed as I realised it was the doctor ventilating the intubated patient. Just a couple of weeks earlier, I was present while a mother gave birth to a child whose twin had died in utero. It was strange celebrating the healthy delivery of one child with the parents, while the other was also in the room, in a surgical tray, lifeless.

“…psycho-social and spiritual support is recognised as an integral part of care”

Now having recently completed a palliative care rotation I have had the privilege of journeying closely with people as their life comes to a close. The calm, reassuring environment of a specialist palliative care ward allows all aspects of the dying process to be fully addressed. Patients’ symptoms are ameliorated, and psycho-social and spiritual support is recognised as an integral part of care. A special dignity is granted to all who have been carefully looked after.

This emphasis on the psycho-social and spiritual aspect of care needs to be embraced personally by students and junior doctors as they inevitably have repeated encounters with death.

Without the social support of friends and family, the suffering associated with death would have become overwhelming for me. I have found great comfort in the informal debriefs that spontaneously happen within groups of students and doctors reminiscing about memorable patients, or lamenting circumstances that have led to poor care or deaths.

“Even the creator of this world laments the presence of death …”

Furthermore, an eternal perspective helps to contextualise these deaths. I have found reassurance in sharing Jesus’ reaction to Lazarus’ death (John 11:35, 38) recognising the sadness and difficulty of this aspect of life.

Even the creator of this world laments the presence of death in this world. Death is such a stark reminder of the consequences of the Fall (Genesis 3:22). Yet we have the comfort of looking with anticipation to a future where there will be no more death and tears, in the eternal presence of the greatest healer of all time (Revelation 21:4).

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