Abstract
Danse macabre
Last week, one of my patients died. Let’s call her Lucy. Her death was well before it should have been – she was a person who lived on the fringe of society, her life punctuated with risk-taking and serious illness. Some may have seen her early demise as inevitable; a product of unfortunate circumstances and poor life decisions. But I must confess that I can only see it as tragic, pointless and possibly preventable. I have thought about her most days since then and about a society, our society, that allows people to fall by the wayside. I wonder about my role in that society.
In our practice, recent deaths are written up on a white board, along with a few details, such as where it occurred. Having only worked in one practice since qualification I have no idea if this is usual. This ‘death board’ sits in reception, hidden from patients but just above the main hub of activity. As part of my early morning routine before I start seeing patients I always check the death board. Emails – check; lab results – check; letters – check; death board – check.
In this way, death has become a regular part of my life. That white board is a continual reminder that death comes to everyone. Sometimes to the young and sometimes to those who were not unwell. The uneasy truth is that most of the deaths I read of do not affect me like Lucy’s has, but I am always caused to reflect. I might take a moment to read through the notes, to evaluate my own dealings with the person who has died. Often there is an informal debriefing between team members and this becomes a time to bond and to express feelings. Sometimes there might be a more formal process of examination, such as a significant event analysis, that leads to further discussion and learning.
Death, which is the only true end-point in primary care, is an opportunity for reflection and evaluation. It is a full stop that forces us to breath. I have come to feel that this regular confrontation with the transience of life is one of the huge privileges of the job. It forces me to think about that person and about my own life and priorities. Is there anything in life that helps you put things in perspective better than the death of another human being?
It is clearly a time for the dead person’s family to reflect too. Although death is an end-point for one person, it can be the start of a journey for their family. Strangely, it is often the time when relatives write to thank us for our care or even bring in gifts. In some situations, it has been my involvement with the death of a loved one that has given me a new rapport with a family.
I have not yet managed to meet up with Lucy’s partner and friends. This leaves me with a feeling of unease – I want to know how they are, to see if they need us, but I don’t want to intrude on their grief. I still find the prospect of meeting up with people who have recently lost someone they loved daunting, but it has never been a painful experience in reality. Grieving people often seem to be immensely unselfish. While I was a medical student, I was once comforted by a mother whose child had died. Such incredible generosity of spirit is a wonderful thing and I am fortunate to have experienced it.
So, although my almost daily contemplation of death can sometimes leave me feeling low or even afraid of my own mortality, I can’t help but be grateful that I do a job that has meaning to it. I love the fact that the mundanities of everyday practice – the costs and the benefits, the resource guarding and the time management – often fall aside as I’m confronted by the fragility of life. What we do is real.