Notes from a Medical Student:

Thanatos

We all face it. We face it from the moment we realize its consequence, finality, and heaviness. Maybe it comes when our pet parakeet flies away, never to be seen again, or when an uncle dies unexpectedly from some sneak-thief arterial block. We are left to confront the greatest and oldest adversary of medicine. It focuses the mind on questions of God, reality, being, soul, and eternity. Beyond its frightening awe and inspiring intricacy, it is as simple for the adventurer into its depths as for those who witness it.

At times, the physician plays little more than a witness. For me, the close, sudden thunderclap of death's arrival brought back those college days when life is so wide and wonderful, and you believe you can't die, you question everything your senses and mind tell you, hoping that you'll have some glimpse of the truth that has evaded capture since our ancestors first asked, "Why?"

48 hours--I sit gazing longingly into my computer like a gypsy peers into a crystal ball, but I find no answers. So instead I pick up my stethoscope as if it were a divining rod and move down the hall toward Mr. M's room. For several days, he has been facing his cancer. There he lies making conversation to ease in my heart. He speaks of seeing his family, his son, his wife. There is hope in his voice and kindness in his words. He manifests all that I hope any man or women could when confronted with such a grim prognosis. He is courageous and calm; goodness incarnate, perhaps. Yet, he lies before me, dying. Oh, not immediately mind you. cancer is a slow mover at times. After all, how could the end come so soon to a man who is so elegant in his speech today?

24 hours--"It's been a pleasure Mr. M," I say, feeling good about what little I've done. His hand reaches into mine and we shake, with warm, strong grasps, containing pride for what one has done and what one has endured. As a medical student you suggest, never order, but feel, as the brand-new intern does, that you've done some good when it comes down to the end of the day. Mr. M will be transferred to another wing of the hospital for palliative care. The wheelchair comes, a tank of oxygen, and off Mr. M. goes. His hand rises and waves as he rounds the corner. I hope he has at least six months left. Six months to ride his motorcycle, to feel the wind in his hair, to feel the wonder of simply existing. I hope and pray his discharge comes quickly, before chemotherapy takes its toll. I tell myself, he is a strong man, and I do the Hollywood double take, almost to reassure some invisible audience, as Mr. M rounds the corner, that all will be well.

The next day--The doors swing open, and I come in out of the cool morning air. I'm tired. Not enough sleep last night compounded by a long ride in this morning. I put my coffee down on the table and go to see a few patients. I talk with them, make sure they are improving in some form or fashion and make my way to the work area to start my notes. As I enter, the resident turns to me and says, "Mr. M died yesterday." At first, it doesn't faze me. Then, I am saddened. "Oh no. That's horrible. He was such a good man." I hang my head for a few moments and then go back to typing my SOAP notes.

On the long drive back home, the reality of it all hits me. As I reach my exit, I pull into the gas station and start to fill up. I flick the clip into position and sit down in the driver seat, with the door ajar. I sit there, my head in my hands, and I think. Not about Mr. M, I'm sorry to say. When I think back on it all now, I feel ashamed. I should have thought of him, his family. But instead I was filled with that awful realization that I too will shuffle off the mortal coil someday. I hold my head in my hands and cry… for myself… for my patient… for my species. I realize at that moment that my circle has widened and I stand up, wiser. Suddenly the latch clicks and the tank is full. I snap the cover and start the car. I pull out and onto the road.

So many years of philosophical training, and I still have no clue how close I am to any answers. The questions that deal with what it means to be human: Who am I? Why are we here? What is reality? What does it all mean? What other questions are there? And how often have you asked them yourself? After so many years, I feel part of becoming a physician lies in the ability to understand what it is to be human.

I look out the passenger window, a field of corn blowing in the breeze, high and green. I smell burning wood, and hear a brass band playing in some small town. And so, I take solace that somewhere, as Ms. Teasdale says, there will come soft rains.