Borgman, Matthew. “A Medical Student’s Reflections on Death,” S. Hamilton, MA: Center for Youth Studies. 

OVERVIEW

Last year, every student of my first year medical class filed into the Gross Anatomy lab to be welcomed by about forty cadavers amidst the smell of Formalin. This was our first real experience with death in medical school…and it was relatively easy. There were no families here, no crying loved ones in the aisles, just nameless corpses lying in bags. There was no discussion, no processing of our feelings of the moment. We simply dove in with scalpel in hand; there was much work to be done. So piece by piece we slowly dismantled this wonderful mystery of science, discovering amazing anatomy and intriguing pathology. Sure, we named our cadaver as most do, but that was not so much to give her humanity as it was a tool for our objectifying her. We could now boast to others about what great pieces of anatomy our cadaver had! Death had long past the specimen on our table. It posed no problem for us. We were there to behold this mystery of science. They labeled her “86-year-old female, congestive heart failure.” We called her “Violet.”

Dealing with the topic of death is a complex and difficult challenge. Generally, no one calls themselves “death experts” or “really good at dealing with death.” The mystery of the human heart is such that death is never easy. But we do talk about our experiences and our feelings surrounding them. Three vignettes illustrate unique and different feelings I experienced around death.

My first experience with death came when I was 12 when I was living with my family in Kenya . We were driving down a stretch of highway north of Nairobi when we saw a crowd gathered around a matatu (a bus-like form of transportation). My father got out and returned with a man carrying a boy about my age. He got in the car next to me so the boy’s head was just inches away. I don’t think he was breathing. His eye’s were rolled back, stained with blood, staring at me. I think my mom said to pick his head up so he could breathe. I don’t know. I couldn’t touch him. His body was lifeless and smashed. I saw his leg bent at the thigh from an obvious broken femur. We arrived at the local hospital where the doctors pronounced him dead. For some reason we waited around in the car long enough to see the family arrive. I watched from the back seat of the car as his mom fell to her knees weeping and wailing, mourning her son. I could do nothing but watch. It was my first experience with death and I felt helpless.

The last time I saw my grandmother I knew it would be my last. She was an incredible woman, strong in her religious convictions, confident that she was going to a far better place than here. She was in her late eighties, bedridden, and ready to go. She died with her two daughters singing her favorite hymns at her bedside. I did not feel nearly as grief-stricken as I felt relieved. Relieved that her suffering was over. Relieved because I believed that she was now experiencing ultimate joy, as I share her convictions.

The day before I graduated from college my mom’s younger sister died of a sudden heart attack. I did not know how to feel as my mom tearfully shared the news when she arrived. I was about to graduate: I had friends to say goodbye to, activities to attend, an aisle to walk down. I went through all of these things a bit dazed, but smiling and feeling the typical things you feel when you graduate from college. However, as I drove away from campus my pent-up emotion poured out all at once. I thought of my two cousins now without a mom. They were only six and nine years old. They needed a mom. This wasn’t fair. I thought of myself at that age as well, and of how dependent I was on my mom. I figured my worst fears at that age were losing my mom. Death was no relief here. I grieved for my aunt. I empathized for my cousins.

These stories represent the vast histrionics that death can elicit. I am not sure they make me qualified in any way to deal with death, but these feelings of helplessness, relief, and grief do reveal the variety of my reactions to loss. As I go through medical practice I will certainly experience the gamut of emotions that surround each death. I may have to simply pronounce someone dead as they arrive from a motor vehicle accident, helpless to do anything. I may watch an elderly patient take in their last breath as they pass away with a DNR order, finally relieved after years of suffering. I may be pained to see the sudden, unexpected death of a young parent or child, perhaps of a patient I had built a relationship with; I would have to deal with the grief of their loss. Additionally, as a physician, I may have to deal with personal feelings of guilt after losing a patient, whether I was somewhat at fault or not.

Dr. Llewellyn offered sound advice to us when he advocated the “team” concept to medicine. He explained the importance of simply talking about our feelings with our colleagues. We will all be experiencing similar things as physicians, and there are certain therapeutic benefits from sharing some of these feelings as we go through life. As I have experienced feelings of guilt and helplessness in the past, I will certainly experience them and need to talk about them in the future. I will also encounter new feelings of guilt over death, and I will certainly need to process those in times to come. I strongly believe in the importance of dealing with stuff and appropriately “letting stuff out.” Several of the stories by physicians in the readings seemed to show the epiphanies brought by the expression of emotion. For instance, during the couple of days I had not “dealt” with my aunt’s death, I felt there was something wrong with me. Something was just “not right.” I think to not deal with one’s emotions is destructive over time as it can harden you to dealing with grief and loss.

Two professional attitudes toward death were modeled to us in class. One instructor seemed to advocate what he called the “Vulcan Reaction,” saying that you have to go into battle as if your life means nothing. There are certainly times when you need to just grit your teeth and continue doing your job. I think especially of the wartime scenario and being exposed to large numbers of dead and wounded soldiers all leaving behind loved ones. There you have to keep plugging along, saving those you can save.

Another professor seemed to advocate an emotionless response. My ability to deal with patients would certainly be affected if I felt that way. I could do my job, but I think I would lose my sanity if I ascribed to a materialistic, nihilistic, “this is all there is” mentality. Another instructor demonstrated that a physician can cry and believed he was a better physician for doing so. As he tearfully recounted the dying moments of an old sailor whose dying wish was not to drown, he shared how he pushed sedatives honor his patient’s wishes while lung cancer overwhelmed him.

Our objective as physicians is certainly not to fight death as the enemy. That is a fight we will ultimately always lose. Our job is to treat the patient. We can certainly fight off death, but we need to keep our eyes on the ally not the enemy. Certainly my own beliefs will shape how I deal with dying patients, as it has shaped how I deal with my own mortality. I feel my beliefs and values enable me to be able to listen and offer hope and encouragement. I recognize these words are easy to type. When I think, though, of a patient looking up at me and asking if they are going to die…or when I have to tell a family their loved one has just died…I am scared. May God grant me strength when the time comes.

QUESTIONS FOR REFLECTION AND DISCUSSION

1. Do you think you would handle the experience of working with corpses any differently than these medical students did?

2. What was this writer’s first recalled experience with death? How would you have taken this experience at the age of 12 or 16?

3. Who has been your closest relative to die? Is it easier when the person is old?

4. What was so difficult about this writer’s loss of his aunt? How would you handle the need to grieve and celebrate at the same time?

5. What advice in dealing with death was given to these medical students? Did you agree with either of the two professors (the “Vulcan Response” and the emotionless response)?

6. Should you lose someone very close to you, what would you most need?

7. How can you help friends and others who have suddenly lost someone they love very much?

IMPLICATIONS

1. Death is not only inevitable, but it can come suddenly when least expected.

2. Sudden death can be especially shocking to teenagers who are able for the first time in their lives to fully comprehend and to feel the consequence of death. It is also a shock to a young person’s sense of invincibility.

3. Young people especially need friends for support when they call through a shocking loss. Beyond their peers, adults who can be with them, listen and support are also very helpful.

Matt Borgman cCYS