This past week we had another death at the hospital. There have been quite a few this summer, which represents a bit of an anomaly for a ward that is populated by a predominance of young and healthy bodies. It has been awhile since I have written of the grief that is particular to the medical provider, and in truth I can really only speak to the unique role of the resident. Myself and my pediatric co-residents often feel a sort of protective shared responsibility for our young patients, given that we practically live at the children’s hospital, and the death of one child affects more of us than the families will likely ever know.
For awhile now I have struggled for the right way to express the sort of mourning process that I experience with each connection and then severance of connection with my patients. For lack of better words, I resort to stock phrasing– grief, sadness, loss–but I can’t help but feel as if I am stealing or appropriating these words from their real owners, from the people who are truly grieving, sad, and at loss: that is, the families. But I also know that we are being honest when we say to each other this is “sad” and “how tragic” and ask each other “are you okay?” and why when the families cry, our eyes glisten too.
The thing is, we seem to know everything about our patients except the actual patient. Our interaction is exceedingly personal, yet very distant. Close yet far. We linger in our call rooms and at our work stations, flipping through lists with names, medical record numbers, diagnoses, medications, problems, and wait for pages and phone calls. We place orders, answer questions, attend to the family and examine the child, then after a few minutes or less, quietly slip out and close the door behind us. We order food and eat our breakfast/lunch/dinner and round with the attending. Go to a conference or two. Back to the computer. Writing notes. A parade of to do items distract the attention, and the art of medicine is reduced to a check list: room 11 is going home. Write some scripts please. Room 12 needs an order for Tylenol. Room 13 is dying and DNR/DNI. Room 14 will be getting a transfusion tonight. Premedicate with Benadryl. Room 15 is asleep and doing fine.
For me, however, familiarity or any sense of knowing someone–any ownership in the matter– is left at the door. The grief and love within the confines of that hospital room feels too thick–like blood–too sacred for a stranger’s intrusion. I sometimes wish I could tell the parent: I grieve, but it is not your grief. I love your child, but it is not your love. I understand your suffering because none of us like to see children suffer, and I understand the child’s suffering because I understand their illness, but in the end I am neither parent nor child. My own children are at home: after my shift I will drive home, find them asleep in bed, and kiss their soft little heads.
I used to think that nothing I said or did really mattered, that it was all empty and meaningless but well meaning lip service. I am still not sure that it amounts to anything more than that for the families. I have, however, found a way in which to think of my own emotional state of being, drifting constantly like this among the sick and the dying, and what it all means to me. I may not mean much at all to my patients, and it doesn’t make a difference if they never remember my face or my name or that I once took care of their loved one: I mourn simply because at that point in time, I was there. I also saw the emaciated cheeks, the swollen hands, the cloudy eyes, the ragged breathing, the graying skin. The touch of death, the smell of it, the horror of the family. The pain and the fear and the fatigue of the child. The anger, the unreasonableness, the insanity, the loss, the denial, the acceptance. Repeated many times over, in various iterations with unique storylines converging to a shared end. I accept that my tears are for their tears, that the pain that I feel is because they hurt, and that I feel for their loss insofar as I can imagine losing my own.
A witness by definition has seen but not participated. A witness also testifies. So this is what I believe: I am bearing witness to their suffering, so I will watch and I will testify. It is the best that I can do, and also exactly what I should do.
The Lord bless you and keep you;
The Lord make His face shine upon you,
And be gracious to you;
The Lord lift up His countenance upon you,
And give you peace.