Open Tears

I often found myself thinking of my own mortality when I was working as a pre-registration house officer. Too many patients died that shouldn’t have, and one often felt helpless in the face of death with too little to give, either because the patient was too poor to afford the best care, or the right facilities were not in place to offer it.

Whenever those thoughts came intruding, and that was often, I would reprimand myself, and struggle to shift my mind to something else, succeeding only rarely. I’d tell myself, re-echoing Shakespeare, that death, a necessary end, will come when it will come, making the case to myself on behalf of the newly deceased patient, assuaging the emotional burden, and trying to get on with my life.

Then it strikes me again that death is what we are as a profession called upon to avert, to postpone, and to fight, a battle in which we oftentimes fail. At those times, my only succor would be to think the good that could come out of death. The consciousness of the dynamic spectrum that spans life and death renders one more sensitive to life, the same way darkness increases the perception of light and bondage the appreciation of freedom.

This seems to me to be the geography of the common ground that health care professionals share with practitioners of the literary arts. The affirmation of life in spite of besetting evidence otherwise. Not many people experience death in its many varied forms, at such close range, and frequent intervals. Caring for the persistently moribund, tending the dying, and some times having to keep the dying aware of the imminent potentiality of death when it exists could be incredibly daunting.

This is a job that has to be done, in the hope that they might be able to savour all the beauty and the ugliness of their world that is fast rounding off before the final knell sounds and the bell tolls and death finally strikes. These are difficult roles, throwing up turbulent emotions, particularly for those that release themselves to the numinous effect of such experiences. I have found myself weeping only once, and in this case the dying patient had been unconscious for days, so it wasn’t the effect of sharing any words with the patient. It was something else. I could identify with the patient on several levels.

The patient was about my age, sustained a puncture injury while playing football, then tetanus, generalised tetanus, with all the spasms, and respiratory failure that put a lot of stress on our lean resuscitative facilities. He was going to die, and there was little more we could do than to keep struggling to bag him to life, and to keep the spasms at bay. That evening, all the efforts were not going to bring him back. I kept bagging though, even after I knew he was long gone.

His mother would frequently ask me how he was doing, and I would try to convey hope, and act like I was doing something important, something that would keep him alive, something, hopefully. When the time came, I couldn’t admit to myself that he was dead, and I found it even more difficult to tell the mother. He was the hope of the family. He had been sponsored through university with the family’s meagre earnings, mostly from farming and petty trading, and he was in his final year, hoping he’d soon start working and earning and giving back to his family, paying his younger ones’ way through school.

Then an elderly nurse came in to join me. She asked me if it was over, not in words but in gestures. I couldn’t respond. She knew it was. She saw it in my eyes. She saw the tears. She waited awhile. When she saw the futlity of my efforts, she called the time of death, and I agreed, reluctantly. I walked out of the room to let off some more tears and dry my eyes. The nurse had broken the news to the patient’s mother before I was back. I heard the greatest wail of my life. It rang as high as it bore deep into my bones. I was re-induced to tears, and all I could do was go back outside to do it.

I relived part of this story to a friend recently, and she told me of a similar experience. In her own case her patient’s parents saw her weep. She felt it might not be a very good thing to have been seen with the tears and all. She had invested a lot of time and emotion in the patient, and thought that she would never allow herself to be so taken again.

The exchange raised a series of questions though. My friend asked me how I would have felt if I allowed the patient’s mother too see me weep? She wondered if it would have left my patient’s mother more consoled, or made her feel better in some way. Or would it have worsened things? We concluded the conversation, dwelling on how it was such a good idea to conduct a qualitative study, investigating what would be patients’, their parents’ and other proxies’ preferences about seeing their carer cry.