Death and the Medical Student

If you want to start crying two days before someone important to you actually dies, go into medicine. By the time your grief process is over, others are just about to begin theirs.

When I came to see my paternal grandfather in the intensive care unit, I knew what to expect. It was a scene I had long become used to seeing: a patient breathing laboriously through a respirator, each inhale-exhale cycle being punctuated by the bleep of the hovering all-in-one machine tasked to monitor his other body functions.

Two days prior, he had a stroke. The cerebro-vascular accident (“It’s not an accident, but a cerebro-vascular disease,” my neuroscience preceptor would correct me.) left half of his body paralyzed and him drifting in and out of semi-consciousness. Perhaps stuporous is the more apt neurologic term.

I knew he was dying. More than that, I knew how.

I had always thought knowing would provide me assurance and security. To know was to tread familiar territory. It meant not having to grapple in the dark for answers which might not even exist at all. Knowing would free me from anxiety, buying me time for other things of more importance.

Then I learned too much, and knowing — what I knew and what it did to me — changed.

Before medical school, being unconscious in the ICU was easily interpreted as succumbing to an illness with a roughly 50-50 chance of survival. When I saw tubes of all sizes inserted at different body parts of a patient, it meant he was suffering and that he could die any moment, whatever the cause of confinement may be. Hell, I did not even know the difference between a stroke and a heart attack.

It was life and death in black and white. Here lies a seriously sick patient, alive today, maybe gone tomorrow, so say your goodbyes.

Medical school complicated all that.

Standing by the bedside of my grandfather, my mind kept on conjuring up images of neurons becoming anoxic-ischemic in synchrony, brain tissue undergoing liquefactive necrosis and an edematous cerebrum causing an increase in intracranial pressure. A voice seemed to interrogate me, “So, is it really a stroke? If it were one, is it an infarct or a hemorrhagic stroke? What made you say so? And where, where is the lesion?”

All the time I was thinking, I could perform a complete neurological exam on my grandfather. I would not take 30 minutes, having had to perform the very same set of tests on every patient during my neuroscience preceptorials. Looking at him though, I knew what results I would get.

I knew that his positive Babinski reflex was pathologic, and that by the Glasgow Scale, he was clinically in coma. I understood what his CT-Scan result meant when it said malignant infarction. I could even explain why he collapsed on the day of the stroke, why he was on osmotic diuretics, why removal of the skull cap was a surgical option, and why he was deteriorating with each day.

Still, there I was: just standing. There was no comfort in that.

Medicine blurs where life ends and death begins. It shows you the gray areas in between, while not necessarily giving you the capacity to delay the progression from one to the other. It gives you a glass wall’s view of everything, even of things unnecessary for you to accept that it is time for your loved one to go.

Many times during my grandfather’s wake, I had asked myself, would I rather not have known?

As a future doctor, I realize death will linger. Everywhere. My lifetime will be spent getting to know death. A lifetime of knowing how people would die, and having to accept that there would be instances when I would not be able to do anything, except watch them walk down the gray area that separates who is from who was.

When I chose to be a medical student, I chose to know. And when my grandfather died, I reaffirmed that choice. I may not have gotten the assurance and security I expected, but I would prefer the surreal burden of knowing over the false hope of not.

I just wish I do not die of a slow-progressing, debilitating disease when my time comes.

8 comments

  1. Ronnie!!! this is a beautifully written piece (not that I expect any less from you) and let me just say thank you for blogging again. You’ve always written from the heart and I will forever be a fan 🙂 Hope to see you again soon (not in consultation I hope)!

    • Thanks Naomi! Really busy with hospital work kaya pass muna sa mga parties. But yes, see you soon. Libre naman consultation :p

  2. I’ve read this the summer before I entered Intarmed (2008) in your old site. It’s awesome that you’re back. Cheers!

  3. I like you stories. I’ll be your fan now…

  4. hi sir! i can fully relate to this article..my mom passed away last year due to a brain tumor, liver cirrhosis and septic shock, she was admitted for 1 month, and I was a clinical clerk at that time at another hospital.. it truly hurts to know everything, and worse, knowing you can’t do anything about it..thanks for this article, it made me feel less guilty and a little better..=)

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