Early one afternoon, we got news of a six-year-old girl who’d come in from home hospital, who had been admitted in sepsis just that morning. Tragically, on the way in, she rapidly declined. The neurologists were called to confirm brain death at four o’clock. I asked to go; I remember thinking “this’ll be a good clinical opportunity, and even a little morbidly interesting.” When I got down to the ICU, I met this second-year medical student who reminded me fondly of a classmate, and we talked until the neurologist arrived. We all stood around the bedside in gowns and masks (droplet precautions) and took our patient off oxygen to test her respiratory drive. There was none, and when they drew her (arterial) blood, it was the colour of grape juice. The second-year, putting me to shame and reflecting a pattern I’ve seen over and over again, was the only one on the medical team to think to wipe the blood from the girl’s nose and to adjust the blanket for dignity’s sake. Obviously, we still owed our patient that dignity, and that’s at the core of my confusion about my time with her. Despite everything, she was still a little girl, a little girl who’d had nothing but a low-grade fever the day before, whose brother asked “is she dead?” fifteen minutes earlier, who still had her ponytail in, and whose foot was so unexpectedly warm when I touched it (out of my own instinct to comfort and a desire to comfort myself). Yet at the same time she was also a medical being; it was our machines that were keeping her body going, after all.
Standing there at the head of the bed, I knew she was dead. Intellectually, anyway. But it didn’t fully occur to me that this duality in front of me was—for hours in actuality, and minutes legally—a dead human being. It didn’t occur to me at first that I should be sad or cry. When it did, part of me argued that I was being melodramatic. After all, I didn’t know her. I’d be crying for an abstraction, I told myself. Plus, I was afraid I’d only be upset because I was supposed to be, like how the neurologist automatically said to the team “it’s always sad, isn’t it?” as she sat down to write the note—not because she was cold, but because she was running on autopilot while she processed the situation. In the end, though, I let myself mourn. I let myself accept that I had been part of that death, in a little way. I’d stroked her foot, I’d adjusted her blanket, I’d seen her face and her little ponytail, I’d learned her name, I’d seen her crying family as I left, and I’d made myself a little vulnerable when my unconscious instinct was to shut down. In one of those silly coincidences that people notice at strange times, when I turned on my iPod to distract myself, the first song up was “The Soft Goodbye.”
*This is all true, in the sense that I’ve captured my experience as best I could. I’ve altered the medical details—which aren’t that important here—for anonymity and confidentiality’s sake.
I am a History student and tea-drinker in my final year of clerkship at the University of Saskatchewan. Once free to roam the professional world, I hope to teach and to work in palliative and hospice medicine