Death, Dying, and a Defense Mechanism

So our school often has us write silly things to talk about our feelings. Which is dumb, since I no longer have any (a lie, but I don't seem to have any today). But sometimes they help me write random things for this blog, like Fixed and Dilated. Anyway, here was the prompt:

 Write about your interactions with a patient who died or was very ill. What sources of inspiration did you find in caring for this patient? How did your team manage the patient’s and the family’s  hope in the face of a poor prognosis or outcome?

And here was my response:

I’ve taken care of a lot of patients that later died.

And now that I think about it: I didn’t do anything special to comfort any single one of them. Because death is a terrible thing, and I wouldn’t want to share my last few days on earth being “comforted” by a medical student. So no, I haven’t actually jumped up to volunteer to annoy someone and their beleaguered family in their last days of life.

[Also, we haven’t been taught how to deal with death, right? Because that wasn’t a lecture and I’m not comfortable dealing with it now.]

But back to me thinking about how I’d want to die…. if I’m still mentally alert, I think I’d want two things: as many pain meds and anti-anxiolytics as I can tolerate and to be surrounded by my closest friends and all my living family members. I also wouldn’t want to be in a frickin’ hospital, but the odds are in favor of that so I guess I should start preparing now. One could make the argument that as you get older, and if you’re dying of a slowly progressive disease, your psychology changes to accept death, which is something I haven’t had to do yet as a “healthy” twenty-something. But I think that’s dumb. I had a patient tell me he was superman, that he was going to somehow defeat/prolong his battle with metastatic prostate cancer—and then I sat outside his hospital room and listened to his freshly-minted widow cry when he died five weeks later.

And I did nothing.

I could only find comfort in the fact that I had at one time spent a good thirty minutes with the patient explaining why we were holding him in the hospital overnight those five weeks earlier. But now I’m not sure if my need to talk through disease processes and hospital operations to the patients and their families is my way of comforting or just the defense mechanism of intellectualization. Because I have nothing to say. You’re going to die. I wish I could do something. I wish we could keep chatting about your interracial grandchildren, or about how pretty my earrings are, or clarifying that you’re at MOUNT SINAI HOSPITAL not in the KOREAN WAR, but I can’t stop your death. I can hold your hand. I can call your children. I can maintain eye contact. And I can tell you as much as I know. Which isn’t a lot.