The Final Destination

How does one deal with DEATH??

The first emotion, once the bewilderment gets over of course, is denial. Then slowly, painfully, the reality sinks in. What next … Shock? Despair? Anger?

But what does it mean to a doctor – specifically when it’s a personal loss?

Frustration. Helplessness. And above all, GUILT.

Most would opine that a doctor is in a much better position to handle death, that a doctor is trained to deal with it. Some may say that doctors are used to it, after all, don't they see it as a matter of routine?? A few would even go to the extent of saying that doctors are so hardened into taking a stoic view of death, that they become incapable of feeling the loss to the extent that a non-medico is likely to feel.

Is all this true?? Absolutely NOT!! Yes, we doctors do see a lot of death – at least most doctors from the clinical sides do – and maybe we do get used to it. But does it mean that we don't feel the hurt?? No, it does hurt. And it hurts every time. Fact is, we are trained just to deal with it rationally and with an unbiased "cool" approach. Doesn’t work every time though. Gently ask if he / she ever developed an emotional attachment with a patient, and many will grudgingly admit that they did. Grudgingly, not because they aren’t "supposed to", but because they probably suffered for it, especially when it ended in losing the patient! Coz what we are not conditioned for is to face death – emotionally. And even more so when it is a loved one, not a patient. That’s when every “training” fails, every defense mechanism breaks down and logic becomes redundant.

Feelings of guilt after losing someone close are the most difficult to handle for anyone, whether or not they belong to this profession. Most would ask themselves if they did enough for the deceased, especially in more recent times... and usually the answer is a big painful NO. I didn’t give him / her enough personal attention. I was careless. I didn’t talk to him / her enough. I was rude just this morning, I fought, I even shouted. Every little thing that wasn’t quite right – but still manageable maybe – suddenly becomes an overshadowing wrong. And the sentiments can be worse… I was too pre-occupied with my own problems. I didn’t call the doctor / ambulance soon enough. I procrastinated in consulting a doctor earlier. And the unkindest cut of all – I wasn’t there when he / she needed me the most…

A doctor faces all these questions, and then some more. Guilt is a much more substantial emotion for a doctor than any lay-person. I could have noticed the subtle signs. I could have checked the blood sugar once more. I could have given the mildly low BP some more consideration. I could have (re)trained in giving resuscitation. I was too busy seeing patients. I was too busy “making money”!! The permutations are endless for a doctor. And worse if you belong to a “non-clinical” or “para-clinical” branch, like radiology or pathology. That’s when the feeling of helplessness becomes even more pronounced. Yes, they may be “doctor’s doctors” but as far as clinical skills are concerned there’s only a theoretical knowledge with no hands-on experience to bank on. It’s the same for other branches like dermatology or psychiatry, which hardly ever face serious situations, let alone with life-&-death decisions. One may know everything, one may think of a hundred and one possibilities, but practically, one isn’t the least prepared to handle most of them, let alone an emergent condition.

What if…?? That’s the ONE question that keeps coming back again and again to haunt a doctor after suffering a personal loss. Being a doctor ensures not only an understanding of the clinical condition of a loved one, it also translates into understanding the prognosis and limitation(s) of medical treatment in a much better and detailed way. And that is the point where the trouble starts. If the prognosis is dismal just to begin with, the feeling of helplessness starts there itself and grows with time. What use is my being a doctor if I can’t help the one I love? No “logic” can dissuade it; any amount of “rationalization” won’t help to handle it. No matter how well one is mentally prepared for it and for how long, when the final moment comes, it exposes one’s vulnerability for all to see.

Indeed, regardless of the profession one belongs to, in facing the death of a loved one every person is equal. Bitter, confused, repentant, nostalgic …and defenseless.

Maybe that’s why it’s been famously called “Death the Leveller”…