Declared

Yesterday, I was at a surgery night shift. Night shifts are always stressful and chaotic, but some are even more so. At some point an ambulance arrived, and everybody just knew and ran to the windows. It's hard to tell how you know. The assessment happens mostly subconsciously, and it's not a medical one; it's instinctive. It's about how the driver is driving, how the paramedic opens the door, it's probably that you can feel the people's emotions within that ambulance way before you can see what's inside; way before the one paramedic shouts "Doctor, get a doctor! Clear the hallway!" while pushing the gurney at full speed, the other one running next to it while pressing rhythmically the chest of the unconscious person.

Many doctors of all specialties are already on the move. The students, we exchange looks. I'm not sure what to do. I'm here for surgery and this is a cardiological emergency. I want to go, for some reason, but I'm also afraid of finding out whether I can handle what I'll see. I stay put, feeling torn, and keeping on doing whatever I was already doing.

Barely five minutes pass and we experience a collective deja vu. A second cardiac arrest arrives and we're all dumbstruck. But that's how it is, the universe just rolls its dice billions of times every moment and improbable events happen all the time. There's no mechanism to make them happen at a more convenient moment, or distribute them evenly across spacetime. A surgeon follows the gurney to the cardiology emergency room and I can't fight the impulse; I follow her, too.

In the room, chaos. The two gurneys are parked next to each other and a large group of nurses, residents, attendants, and interns of cardiology, pathology and surgery are moving in a weird display of purposeful frenzy around them. Two are holding the bags over the mouths of the two patients, two are doing compressions, while others are trying to insert catheters, or setting up cardiographers and defibrillators.

The first one is a small, almost emaciated woman, dressed up in a rock style, with brightly manicured nails, many tattoos and all the physical signs of a regular drug user. It's hard to tell her age, as drug use makes people look older, but my guess would be she is in her mid-thirties. The second one is a man in his early fifties, maybe, very common looking and folk-y, he was the average man. There are three more patients in the room, conscious, pale and scared beyond words for having to witness this.

But it's already too late. Their hearts just won't start again. Her heart is responding to the compressions, his isn't. Soon, it's clear he's too far gone. The attendant calls it. A paramedic comes inside and tells him to inform his wife and son who are waiting just outside. I'm right next to the door. He opens the door, looks at the wife and tells her "Unfortunately, we lost him". As the door swings to close, I have a clear view of her falling apart in the hands of her son, her guttural wail bouncing around inside my brain. My heart contracts painfully, echoing that all-powerful gut-wrenching pain I know that woman is experiencing in that moment. We avoid each others eyes. My eyes prickle, but I don't have any tears.

I have to say, it is a relief watching grown-up, experienced doctors be scared. There is an immature glee aspect to this relief, brought about by years of endless taunting, sarcasm, and pushing around I've had to endure during my studies, but there is, also, something else. When I see hands of arrogant, self-consumed, experienced doctors slightly shaking, when I hear them holding their breath, I see through their hypocrisy. They treat us like we're weak and scared, but that's just being human; and they are human, too. It's a relief seeing that: They care. They try to hide it, to seem strong, to deal with it, for many and any reasons, but in moments like these they can't hide from me.

They're still working on the woman, who had clearly over-dosed. They just found her lying on the street, no clue who she was, if she had family or friends out there. What was her life like, I wonder? What had she been through, what was she like?  I'm sure society has failed her though. I wish I could will her back to us, so she could tell me her story. CPR, epinephrine, CPR, epinephrine, CPR, epinephrine... one minute, five minutes... ten minutes tick and it's over. The brain damage is complete. Someone insists on keeping it up with the unscientific argument of "not two out of two"; but that's just wishful thinking and misunderstanding of statistics.

The surgeon stops the compressions, sweating and panting from the physical effort. She leaves the room of disappointed health professionals and I follow her out. On our way to the surgical emergency department we walk past the grieving wife and son. The pain is cutting through me, acute like a blade.

And the night goes on. While I'm trying to help, I'm searching my brain, looking for signs of a silent break-down creeping up on me, but I find nothing. I think fleetingly of how this will haunt me; how something seemed to have died in me, something like an innocence. But the moment I register the thought I know it’s not “mine”; it’s just what people say, what people write people say in movies and books.

There are more or less three common reactions in the face of death. The first is fear, simple freaking out. Death scares us, rips the people we love away from us; comes hand-in-hand almost always with pain, disease, and suffering. The second is a kind of selfish and bittersweet gratitude that you’re still alive. Selfish, because a person just died and you are thinking about yourself; bittersweet, because you know it’s temporary. You’ll die, too, eventually, and probably sooner than you expect. The third is a seeming indifference. Some people seem completely untouched by death. Some talk about it with surprising carelessness. Obviously, there often are combinations of these in each person and case.

However, I wasn't scared. I wasn't grateful. I wasn't indifferent. What I truly felt was that I had the complete picture at last, not only as a med student, but as a living being.

We've distanced ourselves from death; and life. We've distanced ourselves from experiencing fully. The part of new age philosophy that has it right is that we do care about nonsense. We pay too much attention to and waste too much energy for things that are not important. I wish we sang in buses and danced in the streets. I wish people would share their emotions more. I wish pomposity and up-tightness were not mistaken for responsibility and professionalism. I wish insensitivity was not confused with strength, and caring for weakness.

Where new age philosophy has it wrong is that it celebrates gratitude so much that it equates self-consumed whining with struggling against inequality and injustice. Being grateful even for the bad things in life, simply because it means you are alive is a good example of mood incongruence. What's mentally healthy is to be sad when sad things happen and happy when happy things happen. We can talk about the limits of the intensity of normal emotions, as well as how much fluctuation is too much fluctuation whatever the stimuli, but in the end asking people to be happy independently of what's going on around them is downright sociopathic.

After all, the essence of many unhealthy relationships is being too grateful you have that person in your life that you make excuses, disregard, accept, and take as a given their harmful behavior.

So, the mature thing to do in the face of death is to get things into perspective.

If I am to be honest, I'd probably not like these people very much on a personal level. I don't like most people on a personal level. Most people do not rise up to my standards of intelligence, kindness, conscientiousness, consistency, professionalism, humility and all the other things I value in a person. But my arrogant and hypocritical elitism, since by default not even I rise up to my own standards, is not the point of this post.

The point is that no matter whether I'd like these people or not, I'd still want the best for them.

The point is that life is rare. Life comes with love and happiness, it also comes with pain and suffering; and empathy is the answer. What could ever be our purpose if not building a society as nice, kind, and beautiful as we possibly can, while enjoying and making the most of the time we have?