I haven’t cried for a patient in more than five years. I worry I’ve become a cold-hearted bitch who makes small children scream, jabs old ladies with needles, and remains unfazed in the face of relentless suffering.
Sometimes I have to fight off the urge to laugh as some sort of perverse knee-jerk reaction to misery because I don’t have time to cry for every dead patient. I can have up to 250 under my care. By some typical twist of fate, it would be in the two minutes it took me to dry my tears on my bloody scrubs that another one would arrest, doubling my death toll.
I remember my first death. It was a crotchety old man who looked like Mr. Magoo with bad pneumonia. His eyes had already glazed over and he had gone that unusual shade of morgue grey that signposts the end. I took his daughter to one side for my first “death chat,” carefully recalling my six-step training for delivering bad news. It went well and she appreciated the time I took to talk to her. I left for the night leaving her by his bedside waiting for him to pass.
When I came in the following morning he was up in bed, shaking his little old fist, shouting, “Balls!” From close-to-death he had been reborn as a geriatric terror. I went to check on him and he asked, “Am I all right?” I reassured him, that he appeared to be doing much better. Then began his tirade, “Balls! I’m not fucking all right! Do I look all right? I’ve been here for days without food. It’s a disgrace!” Still shocked by his miraculous resurrection, I agreed to give him some dinner. Within hours he let out one last, “Balls to it all!” before conking. I felt cheated. Like he had pretended to get better to taunt us with cruel hope before dying, most likely from his own sour mood…and possibly our sour food.
Much like dumping boyfriends, you get increasingly callous and efficient every time you deliver the death chat to a patient or relative. You become savvy about the small signs that indicate if they will be an arm-flaying screamer, a quiet controlled crier, a raging hater who hurls abuse and blames you for not trying hard enough, or just a shell-shocked jaw-gaper who can’t even register what you are trying to tell them. That doesn’t even begin to cover the spectrum of reactions from trite to gut wrenching. One woman, after I told her that she only had three months to live, asked, “What transport do they provide to the hospital?”
Mr. Magoo initiated me into the various stages of dying. The first indicator generally is when a patient announces, “Doctor, I think I’m dying.” It’s sometimes hard to tell which ones are just being melodramatic and which ones mean it. The next warning sign is a swift and remarkable recovery. Terminal patients have a tendency to get better the day before death. Finally, people turn gray and their eyes glaze over. Then it’s game over. The switch from Beryl, the nice little old lady on ward three, to Beryl, the corpse, is rapid. After death, whatever made that corpse Beryl has vacated her body.
Finally, last words are a myth. No one has ever said anything profound or witty in their choking gasps. Most often they tell my they need to pee, which I now treat with great suspicion in the near dead. Though I’ve always thought Mr. Magoo had a point when he wailed, “Balls to it all!” for the last time.
DR. MONA MOORE