The Hardest Day

Second year has started off with a bang. If you are paying attention, you’ll see some crazy stuff in any medical school. Whether it’s an official lesson, or people watching, or patient encounters, or something you learn on accident while researching something else, there will surely be something to learn. Recently we had a deep lesson that I wanted to share, but first I need to set the stage.

All of the MS2 students are packed into our lecture hall. This isn’t the nice, new lecture with comfortable chairs that we used last year. This is the older lecture hall that doesn’t have enough seats for the whole class, the one with the terrible chairs, and the one with not enough room for your laptop and anything else on the desk. There are students standing in the back, and everyone looks sharp because we all are wearing our white coats and professional clothes.

On stage are six people. Standing at the podium is a Pediatric Hematologist who is running the event. She has a very serene demeanor, but seems to radiate strength from her small stature. Sitting at the table on stage are 5 others. There is a couple in their 40’s. He is lean and tan, with the muscle tone and hands of a construction worker. She sits next to him, well dressed and confident, if somewhat anxious. Another lady sits next to them. She is African American, somewhat heavyset, with a joyful face, floral blouse, and somewhat excessive afro. Next to her is an elderly little lady with thin gray hair and a stooped posture, and she is in deep conversation with the woman beside her, who is wearing scrubs and has two phones and a pager.

This is a lecture panel on handling the death of patients, specifically children. The couple on the end lost twin boys, their 5th and 6th children. The first died before being born. The second lived for 10 months, but had a debilitating matrix of health problems and lacked any ability to develop. The lady next to them had a daughter who developed bone cancer at age 11, which metastasized to her brain and took her life when she was 13. The older was a chaplain, and the last lady was a NICU nurse. Everyone was there to talk to us about handling death.

Most learning in medical school is very clinical and sterile. We learn about our bodies from distinguished looking old professors who wear white coats and use technical language to describe anatomy and physiology of organs and diseases, of which they are experts. That approach is obviously not practical when talking about handling death, so we learned from “experts” in their own way, people who had gone through this and were willing to talk to us about their experience.

I don’t like thinking about death, and I don’t think many of my fellow students do either. We are all young and vigorous, filled with the energy and optimism of youth. In my mind, death is something far off. It’s not that I’m scared of it, I just prefer not to think about it. I have been very fortunate to have made it this far in my life with living parents and grandparents.

This forum was not the first time that I had focused my heart and mind on this idea of death, and current events will tell you why. On Saturday evening the violence in Ferguson, MO erupted after a young man was shot and killed by police. Even as I write this tensions remain high, with protests and heavy police presence keeping the conflict in the national spotlight. It was only a few days ago that the world was shocked to discover that Robin Williams had ended his own life. Violence in Iraq and the Middle East have created a summer that will go down in history as a violent, restless summer.

I don’t want to talk specifically about any of those subjects listed above, at least not in this post. Instead, I want to talk about dying. The way someone reacts to death will tell me a lot about the way they view the world.

Death is a part of life, just like birth. Everyone is born, and everyone will die. What we do in between is what makes the difference. Death is also a great equalizer. I learned this lesson at a young age helping my dad clean our boat after a day on the lake. He always said that the boat ramp was the great equalizer. At the end of the day, everyone comes back to the ramp and goes home after a fun day of boating. It doesn’t matter how big your boat was, how big the truck you used to tow it, or how many fun inflatable things you could pull behind your boat. At the end of the day everyone comes back to the ramp sunburned and tired, and everybody had fun.

So when we die, as we know we will, we are all equalized again. Your influence, your money, and your responsibilities are all lost and left behind. What happens to you after you die? What or where do you think you will be after you die? Some believe that death causes you to cease to exist, but I find that hard to accept and impossible to believe.

The hardest part of the last few weeks has been actually organizing my thoughts on this matter. It’s not easy to do, when my cell phone keeps ringing, emails keep arriving, and the world flies by on my laptop screen. It’s easy to ride the wave of now, caught up in an endless progression of thinking about what happens next. Thankfully, I found the time to take my dog to a local state park and hike. So it was there that I hiked miles from any road, on trails not commonly traveled, and sat down for a water break. The sun was high in the sky, coming through the trees to turn the world green. Except for my trampling feet, the world was perfectly still. So I sat there for a long while, and I’m glad I did, because that’s how I was finally able to write this.

Lastly, I wanted to leave with the words to a poem. It was written in the 1600’s, but people then died at the same rate as they do now, and the words speak to people today just like they did 400 years ago.

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die.
Thanks for reading!
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