The Inevitable

Recently I saw a patient at family practice who proceeded to lecture us on death, the immortal soul and quantum physics (and no they were not terminally ill).  “Death influences the actions of everyone” said my preceptor after the fact.  Some patients display an obvious fear of death, constantly visiting their family doctor, why? Because they fear a symptom (however minor) could be suggesting their approaching demise.  Even for those that appear ‘fearless’ their actions reflect the finite nature of life.  Why did we make such a big fuss to see the super-moon lunar eclipse of 2015? Because who knows if we will be around for the 2033 one.

“It is not until you confront your feelings and fears about death that you can truly provide the optimal care to your patient.” This was told to us in lecture.  My memory of the exact words are fuzzy, but the concept is not.  Of all occupations, it is especially important that those in health care not ignore the fact that, one day, everyone must die. But to be fair, as a medical student, I have no idea how one could escape confronting this.  You learn about terminal illnesses in class (most well known, cancer), you discuss their prognosis, your mom calls saying her friend was diagnosed with pancreatic cancer (terminal), you see on Facebook that a undergrad classmate is in the hospice with brain cancer (terminal).  As much as you can try to avoid confronting it (despite the advice of our professor), you really can’t.

As a first year medical student I still struggle with the thought of death (not really a surprise, I’m sure it is struggle that many face their entire life).  I do not think about it on a daily basis, it is more so dependent on what we learn in lectures i.e. when we learn about terminal illness.  Sometimes I think I have almost accepted it (it’s a natural process right? what are the chances of evening being born in the first place?), but then something (or someone) happens and I cannot imagine having to say good-bye forever.

I think this evolution in thinking about death is reflected well by the hypochondria (also known as medical students’ disease) in medical students vs. doctors.  For those unfamiliar with ‘medical students’ disease, it is the common phenomenon that many students become convinced at one point or another that they have the disease they are studying.  A cough suddenly becomes a potential lung cancer, a bruise potential liver failure.  Laughable? Not really for us.  However, the opposite applies to doctors (apparently).  They think they are invincible and that no severe illness is applicable to them, death no longer appears to phases them (at least superficially).  That is until they are forced to face their own.  Recently a book was published titled “When Breath Becomes Air”, I admit I have not read the book, although I have read about it and just bought the book yesterday.   “When Breath Becomes Air” is an autobiographical book was written by Dr. Paul Kalanithi, a neurosurgeon diagnosed with metastatic lung cancer at the very end of many many years spent in education and training.   A  quote from the book:

“I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.”

Dr. Kalanithi died at age 37, but not before writing this book attempting to answer the question: in the face of death, what makes life worth living?  I encourage you to try and ask yourself the same.

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“Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.”

—Atul Gawande

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