User login
Death is no stranger to me. Like many my age, I have lost all my grandparents, but I also lost my dad early, when I was only 18. In my early 20s I saw death hundreds of times as an assistant to the medical examiner. Now, as part of my job, I routinely help families and patients approach this last and final stage of life.
Despite this familiarity, I somehow forget what the cold, harsh finality of death personally feels like; the incomprehensible irreversibility, the eerie emptiness. Patients often pass during the night, leaving me to find, the next day, their name off my list and their room being cleaned. I sign the death certificate and move on. It is, after all, part of my job.
Now and then death will touch me directly, and I am reminded anew what it is really like, beyond a "goals of care discussion" and a death certificate.
First there is the stunned knot in the stomach when you first hear the news; the pit of lost words and imploded emotions. Then comes the sadness followed by the unexpected and surreal work that has to be done. Emotions are briefly put on hold to "get things in order." Then, when all is said and done, you have to return to the empty nuances of life: work, bills, chores. You walk through the motions, trying to act the same. The world goes on.
Today I woke up to find that my friend and pet of 8 years had died in her sleep. She had been battling infections for a year and a half, had become incontinent, and was losing weight. I knew it was coming, I just didn’t know when. In evenings, I would find myself taking pause to look for respirations when she would rest in the shade. Then today, a day no different from any other, it just happened. Of course I knew instantly; there is such an indescribable difference between a lifeless body and one who still has even shallow breath. I just stood and stared. I told my wife and I watched the same helpless feelings pour over her.
This loyal rabbit, our friend, had been with me since I rescued her during medical school. At the time, I was not keen on owning any animal, let alone a little rabbit. But she needed rescuing and thus I adopted her. Then, through the loneliness of medical school clerkships and residency, she became my friend, often my only friend. She was a faithful companion that ran circles around my feet when I would come in the door after 30-hour shifts, and she would curl up next to me during post-call Netflix naps. When my wife moved to the United States in the middle of my residency, she was often her only companion for days at a time as I worked long hours in the ICU. She was with me through every relentless minute of studying for boards, sleeping quietly at my feet.
After we had a good cry came the cold requisite to "get things in order." We said our final good-byes just 2 hours ago, and we returned to the empty nuances of life: Fix the leaking faucet, eat dinner, do the dishes.
Working with patients who are sick and nearing the end of their lives can be part of our rhythm – monthly, weekly, or even daily. But for the patient and family, there is nothing rhythmic about it; death is a life event, perhaps the life event.
Quality of care can mean creating a temporal space of peace and honor, no matter the loss and however brief, that has a different tone from the rest of our day. It means never suggesting in word or deed that we are too busy to recognize the emptiness that the death will leave behind. It is understanding the initial thud that a palliative care/hospice referral makes on a loved-one’s soul. Even a novice physician or nurse should pause in recognition that though the hospital bed will be refilled and the hospital workload will continue, for families, nothing is ever quite the same.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
Death is no stranger to me. Like many my age, I have lost all my grandparents, but I also lost my dad early, when I was only 18. In my early 20s I saw death hundreds of times as an assistant to the medical examiner. Now, as part of my job, I routinely help families and patients approach this last and final stage of life.
Despite this familiarity, I somehow forget what the cold, harsh finality of death personally feels like; the incomprehensible irreversibility, the eerie emptiness. Patients often pass during the night, leaving me to find, the next day, their name off my list and their room being cleaned. I sign the death certificate and move on. It is, after all, part of my job.
Now and then death will touch me directly, and I am reminded anew what it is really like, beyond a "goals of care discussion" and a death certificate.
First there is the stunned knot in the stomach when you first hear the news; the pit of lost words and imploded emotions. Then comes the sadness followed by the unexpected and surreal work that has to be done. Emotions are briefly put on hold to "get things in order." Then, when all is said and done, you have to return to the empty nuances of life: work, bills, chores. You walk through the motions, trying to act the same. The world goes on.
Today I woke up to find that my friend and pet of 8 years had died in her sleep. She had been battling infections for a year and a half, had become incontinent, and was losing weight. I knew it was coming, I just didn’t know when. In evenings, I would find myself taking pause to look for respirations when she would rest in the shade. Then today, a day no different from any other, it just happened. Of course I knew instantly; there is such an indescribable difference between a lifeless body and one who still has even shallow breath. I just stood and stared. I told my wife and I watched the same helpless feelings pour over her.
This loyal rabbit, our friend, had been with me since I rescued her during medical school. At the time, I was not keen on owning any animal, let alone a little rabbit. But she needed rescuing and thus I adopted her. Then, through the loneliness of medical school clerkships and residency, she became my friend, often my only friend. She was a faithful companion that ran circles around my feet when I would come in the door after 30-hour shifts, and she would curl up next to me during post-call Netflix naps. When my wife moved to the United States in the middle of my residency, she was often her only companion for days at a time as I worked long hours in the ICU. She was with me through every relentless minute of studying for boards, sleeping quietly at my feet.
After we had a good cry came the cold requisite to "get things in order." We said our final good-byes just 2 hours ago, and we returned to the empty nuances of life: Fix the leaking faucet, eat dinner, do the dishes.
Working with patients who are sick and nearing the end of their lives can be part of our rhythm – monthly, weekly, or even daily. But for the patient and family, there is nothing rhythmic about it; death is a life event, perhaps the life event.
Quality of care can mean creating a temporal space of peace and honor, no matter the loss and however brief, that has a different tone from the rest of our day. It means never suggesting in word or deed that we are too busy to recognize the emptiness that the death will leave behind. It is understanding the initial thud that a palliative care/hospice referral makes on a loved-one’s soul. Even a novice physician or nurse should pause in recognition that though the hospital bed will be refilled and the hospital workload will continue, for families, nothing is ever quite the same.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
Death is no stranger to me. Like many my age, I have lost all my grandparents, but I also lost my dad early, when I was only 18. In my early 20s I saw death hundreds of times as an assistant to the medical examiner. Now, as part of my job, I routinely help families and patients approach this last and final stage of life.
Despite this familiarity, I somehow forget what the cold, harsh finality of death personally feels like; the incomprehensible irreversibility, the eerie emptiness. Patients often pass during the night, leaving me to find, the next day, their name off my list and their room being cleaned. I sign the death certificate and move on. It is, after all, part of my job.
Now and then death will touch me directly, and I am reminded anew what it is really like, beyond a "goals of care discussion" and a death certificate.
First there is the stunned knot in the stomach when you first hear the news; the pit of lost words and imploded emotions. Then comes the sadness followed by the unexpected and surreal work that has to be done. Emotions are briefly put on hold to "get things in order." Then, when all is said and done, you have to return to the empty nuances of life: work, bills, chores. You walk through the motions, trying to act the same. The world goes on.
Today I woke up to find that my friend and pet of 8 years had died in her sleep. She had been battling infections for a year and a half, had become incontinent, and was losing weight. I knew it was coming, I just didn’t know when. In evenings, I would find myself taking pause to look for respirations when she would rest in the shade. Then today, a day no different from any other, it just happened. Of course I knew instantly; there is such an indescribable difference between a lifeless body and one who still has even shallow breath. I just stood and stared. I told my wife and I watched the same helpless feelings pour over her.
This loyal rabbit, our friend, had been with me since I rescued her during medical school. At the time, I was not keen on owning any animal, let alone a little rabbit. But she needed rescuing and thus I adopted her. Then, through the loneliness of medical school clerkships and residency, she became my friend, often my only friend. She was a faithful companion that ran circles around my feet when I would come in the door after 30-hour shifts, and she would curl up next to me during post-call Netflix naps. When my wife moved to the United States in the middle of my residency, she was often her only companion for days at a time as I worked long hours in the ICU. She was with me through every relentless minute of studying for boards, sleeping quietly at my feet.
After we had a good cry came the cold requisite to "get things in order." We said our final good-byes just 2 hours ago, and we returned to the empty nuances of life: Fix the leaking faucet, eat dinner, do the dishes.
Working with patients who are sick and nearing the end of their lives can be part of our rhythm – monthly, weekly, or even daily. But for the patient and family, there is nothing rhythmic about it; death is a life event, perhaps the life event.
Quality of care can mean creating a temporal space of peace and honor, no matter the loss and however brief, that has a different tone from the rest of our day. It means never suggesting in word or deed that we are too busy to recognize the emptiness that the death will leave behind. It is understanding the initial thud that a palliative care/hospice referral makes on a loved-one’s soul. Even a novice physician or nurse should pause in recognition that though the hospital bed will be refilled and the hospital workload will continue, for families, nothing is ever quite the same.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
