Death do ye fear?
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.
February 27th, 2007 at 3:34 am
for me i would like to die peacefully without pain with my loved ones by my side. This is how I would like to meet my maker. I would like to live each day savouring life with people you love and have wonderful memories. That would then make death alot easier to face.(?).dunnolah….
February 27th, 2007 at 7:08 am
Everyone loves to die without fear and pain. Most of the time we wish to have our loved ones close to us but for Raj, it was different. He refused at one stage to see me and the kids. I understood why only later. For the very reason he does not want to be remembered the way he was at his final stages. Especially for our children, he refused to see them at all in the hospital, visiting him. It is not because he hated them, it is because he loved them just too much. Raj wanted to be remebered as the “daddy” that brought home sweets, chohcolates and ice-creams for Pattrena and Shermenraj. I am glad that I stood by him until his last breath.
February 27th, 2007 at 9:13 am
Thanks for your article on thalessemia, I have it so it’s good to know more. Oso thanks for taking care of my kopitiam for me when I was gone. Regarding death, well when I faced it during the delivery of my son, I slipped into nothingness and that comforted me a little making me belief that when death comes we will just slip into nothingness.
February 27th, 2007 at 11:20 am
Dr George, sorry to hear about your brother-in-law. My sincere condolences to you sister and children, you and all in your family,
God knows my heart’s desire but we all live in His plans not knowing where it will lead us, don’t we?
Having read your sister’s comment, I believe he was a very brave man and felt he needed to do what he had to for the sake and love for his family.
I try not to think about death but like one of the elderly patients said to you that he’s not afraid and ready to go because his ‘lived’ and has seen his children grown up, etc. He was contented and ready. It would be nice if I live to a ripe old age (seen my children’s achievements) with no medical problems and just go in my sleep.
February 27th, 2007 at 3:14 pm
Your post brought up a surgical question of mine that has been floating around for some time. I notice quite a number of surgeons tend to do an upper scope first for fresh PR bleeding, then proceed to a lower scope if the former is ‘clean’. Wouldn’t it be more ‘efficient’ to go for a lower scope first since it is hematochaezia?
February 27th, 2007 at 5:57 pm
Well sis, yes don’t we all wish that.
Wow, Firehorse, thanks. Well slipping to nothingness is a nice way to put it. It is like free-falling I guess except without the fear of hitting ground and shattering brain matter. He he!
Judy, wow two bloggers with thalassemia. There is more but I wanted to keep it brief. ” we all live in His plan” - yes I agree but life is full of choices and I have to believe that whatever the choice taken, the end result is still the same, His aim! It is just the matter of whether the choice makes the path easier and memorable or a painful but learning experience.
February 27th, 2007 at 6:28 pm
huajern, thanks for asking. Well the issue as always is why do an upper endoscopy in a person presenting with fresh PR bleed? As obvious as it sounds, shockingly upto about 20 to 30% of this fresh PR bleed have a upper gastrointestinal cause. Thus the need to perform OGDS first as it is an much easier and more feasible. I once (or maybe more than once) had a patient with an active spurter in the first part of duodenum and presented with fresh bleed from the top and bottom.
February 28th, 2007 at 8:31 am
I also want to go swiftly ( and painlessly) or silently in the night. But dying in this manner may cause one’s loved ones to be in a state of shock sometimes. It is always the loved ones who struggle to live on. Dying after a spate of illness will make them accept the loss better as they have been mentally prepared and also, they know that death releases one from suffering.
February 28th, 2007 at 1:49 pm
Like what Firehorse said we probably do slip into nothingness at the end. Into oblivion. A true no existence. The concepts heaven and afterlife are there, probably, for no greater purpose than to comfort the living before they also join the dead.
And I am not sure if that is really comforting.
While the living may miss the dead, I believe the dead must truly miss their ownselves, if there is such a thing.
February 28th, 2007 at 5:02 pm
wow the dead must truly miss their ownselves - that is deep! Never thought about such! Thanks for visiting,AB
March 2nd, 2007 at 6:21 pm
Hey, you know what. I’ve this perculiar experience. I dreamt about my tough struggling last moment in sleep many many years ago. Oh boy.. it was very real. Post effect? I’ll make sure to do all the things that I should or ought be doing for NOW ..
Back to the question… , I may fear a little in the beginning. But one thing I realized from the dream was, the harder you struggle, the more painful it gets. If life has to ends inevitably, no choice lo. Have to accept it with open arms. Oh yea, I “died” happily in my sleep after a tough fight!
March 3rd, 2007 at 9:40 am
Yo! so vivid dreams hoiling! Acceptance is the issue, this one of those thing where talking is easier than doing.
March 3rd, 2007 at 11:33 pm
I faced it with a few of my loved ones, seeing them die. Worse of my grandad who died of multiple cancer *(don’t ask) and even on morph, he was in pain.
yes, death breaks ANYONE down, even doctors who face death on a daily or hourly basis.Mine, was to bury my own loved ones and to call their time of death.And to do their autopsy was too much.
It’s a sad feeling and yet death will come to us, whichever way.
And what people saw when they are in comatose are true, that your spirit roam as how a ghost is.
Take care my friend.Sorry for your loss.
Best regards
Azrin @ http://www.azrin.net
Thus a factor attribute to me losing my medic license and memories.
March 4th, 2007 at 9:30 am
Azrin, welcome! I have difficulties leaving a comment in your blog but then maybe I am blind to the buttons attached somewhere if there is!
Hey Azrin, such a traumatic life. You have pulled yourself well. But what you said in your post ” Yet life goes on. I have not just lost my friends I bear dear to me, but also a sense of identity. I also lost my loved ones too, and my two boys in the process. I was no longer myself. WHO I AM does not matter anymore. It’s what I am.”, is very disturbing. Maybe I haven’t grasped life as much as you have but I have a feeling that it is very true.
It is probably true, about patient close to death being able to see things. I was doing rounds and seeing this elderly gentleman who had a cardiac bypass done. He was recuperating after a stormy post-operative period. This was my night round. He was silent and kept very quiet and still. He stared at me with a coldness that for the first time made me feel very uncomfortable with him. The discomfort that sometimes makes you wonder whether is all things right with the patient. All was in check. He was fine. As I walked away to the next patient, he asked my nurse who was the old man beside me. There was none obviously.
March 4th, 2007 at 5:07 pm
Tell me about it, seeing so much..especially when U have to serve in the forces and in war torn areas, it just…get to you. And well, I love the night rounds cos I can be a sense of peace, amid the rush in the A&E when I am always called to during the midnight rush hour.
Honestly,come to a time, we become walking zombies when it gets to you.At times its hard to differentiate reality and spirtual. Won’t go into that details here, but I’m more than happy to share it with you.
I now find joy in my life as a dad and a husband, given the second reprieve of what had happened to me. And to think we are here to save lives, not end it, makes one wonder.
And sorry , I forgot about the anti-spam thingy.My SPAM DOG keep on eating up everything.
May 22nd, 2007 at 8:41 am
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