I have always asked myself this question. Being in the medical field, death is almost an everyday event and initially it hits the soul but eventually one feels a little numb to death. Another favourite question that frequently crops up is how would one prefer to die – a swift death, a chronic illness leading to death, a painful death or a silent-in-your-sleep-kind of death? Can one confidently say that he is ready for death and he fears not death?
It was more than year ago, when my sister’s husband was diagnosed as early lung cancer. He was marathon runner and was in disbelieve with the diagnosis despite having smoking as a strong risk factor. Upon realising his rejection to treatment, I tried talking to him to change his decision. In that particular conversation, he mentioned that he is prepared to face death. The months past fast and barely 6 months later, he was already cachetic and could barely walk. He was in severe pain and was having stridor and a change in voice. The cancer had grown five times its size and has spread. He needed a tracheostomy and was fed through a nasogastric tube. The pain was crippling and despite the medications, it only made him weaker. It was then, I saw fear in his face. I gather he saw flashes of his life and suddenly he felt he was not ready for death. Fear was gripping him and he was fighting, and with every fight, he grew weaker. I motioned to him that all was fine but he had many unsettled things. He however managed to lay them out for my sister, before he gave his last breath with my sister beside him.
Another friend of mine, a doctor, whose father fell ill with a stroke. It was a lethal stroke that would render many dead. His father however, was now intubated and ventilated. Knowing the risk and prognosis involved, he calmed himself and put on courageous front. He told me that he was ready for the worst. The worst being death. Sepsis flared through his fathers veins from a chest infection as he continued to deteriorate. He kept watch over his father, but when he saw his colleagues doing the cardiac massage and the news of death conveyed, he fell to the floor and wept. He plunged into depression. It took him more than six months to just come to terms and then he said, ” No one is ever prepared for death”
Strangely though, I have come across many who request to be killed by lethal injection. Just three weeks ago, a chinese gentleman in his late 40s presented to us with profuse bleeding per rectum. He was unstable and was confused. A upper endoscopy was clean and I proceeded to perform colonoscopy. As I was positioning him, he gestured to me three times to give him an injection to put him out. The colonoscopy was not complete as it was dark and filled with thick blood. That night we actively resuscitated him and rescoped him the coming morning. He bled again in the wee hours of the morning. This time the scope was better. What I thought I saw in darkness, was correct. He had multiple colonic ulcer for which I treated endoscopically. Even then, he took the oppurtunity to once again inform his wishes for death. All this while, I flatly refused him. The following day, the bleeding had stopped and he appeared much better. I told him about his wishes, and he says he would not regret dying!
Another patient, was admitted during my internship for intestinal obstruction from an external hernia. Upon giving some anlagesics and sedation, his hernia resolved and his plan for surgery was cancelled. This is the fourth time he was faced with such a situation. He bravely told us , ” Uncle is very old, dying is ok! My children are all big and independent and I have nothing more to achieve. I just cannot bear the pain if it occurs again and am willing to take risk of dying.” This caused the department to break into two groups, the patient’s men and the boss’s men. Obviously, the boss rule stands and we had to send him home with advice.
I leave this article with a poem from Khalil Gibran, and for myself, I am not ready for death but if it has to come then either let it come swiftly or quietly in the night.
On Death
Kahlil Gibran
You would know the secret of death.
But how shall you find it unless you seek it in the heart of life?
The owl whose night-bound eyes are blind unto the day cannot unveil the mystery of light.
If you would indeed behold the spirit of death, open your heart wide unto the body of life.
For life and death are one, even as the river and the sea are one.
In the depth of your hopes and desires lies your silent knowledge of the beyond;
And like seeds dreaming beneath the snow your heart dreams of spring.
Trust the dreams, for in them is hidden the gate to eternity.
Your fear of death is but the trembling of the shepherd when he stands before the king whose hand is to be laid upon him in honour.
Is the shepherd not joyful beneath his trembling, that he shall wear the mark of the king?
Yet is he not more mindful of his trembling?
For what is it to die but to stand naked in the wind and to melt into the sun?
And what is it to cease breathing, but to free the breath from its restless tides, that it may rise and expand and seek God unencumbered?
Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance.
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