“I'm frightened. I think I'm going to die”
The words reverberate through the room, the very air becoming taught. Gathered around the bed, we stiffen with the discomfort of not knowing quite what to say. My mind fumbles, barely-formed sentences struggling to take wing. The gulf of our disparate experiences seems to stretch between us; a frail, 91 year old woman and two young student doctors. It occurs to me how foolishly young we must seem to her; like children, green with naivety. Audrey struggles against the BiPAP that's keeping her alive, driving the air into her lungs, then sucking it out again.
“Can you take this mask off, please!”
I glance awkwardly at my fellow student doctor. In the family meeting earlier that day, it was agreed that the mask would be left on until Audrey's sister and brother-in-law could be present. I'm caught between fulfilling a dying woman's last wishes for comfort and the authority of more senior doctors, the medical management in place to keep her alive for her family's final farewell. I consider going to ask the senior doctors if we can remove the mask, despite the earlier plan. As I rise to ask...
“No, don't leave me! I don't want to be alone!”
We are witnesses to a private battle; Audrey grasping for life even as her strength fails her. Illness and the medical interventions of the last few days have weakened her, and like gravity, she seems to be drawing down, down, and yet still straining to breathe, still tightly squeezing onto life.
“It's okay to be afraid.”
My words are ill-formed clay.
“It's natural for you to be afraid now. But we're here to help in any way we can. What can we do for you?”
My mind flicks back and forth between believing I've just said something commendable for it's sincerity, or regrettable for it's ill-advised audacity. I wonder if anyone has told her she will die soon. My mind stings with the memory of how well she had appeared that morning. My entire mind clamours with thoughts, remembrances, worries.
After what seems like an eternity, the senior doctors return with Audrey's family. The BiPAP mask is removed, seemingly to Audrey's relief. Words come with such difficulty now. We leave Audrey and her family in their private room, for what little they have left. At the nurse's station, our registrar takes stock, asks us how we feel, a moment to reflect. I don't understand why I feel so upset. I didn't think I would be so affected by the dying of a woman I barely knew.
“How are you feeling, Konrad?”
We return to check on Audrey and her family. Audrey doesn't seem very aware any more. Her breathing is shallow, and a froth collects at the edges of her mouth. Her family sings us a charming song, about their childhood and “the girls of Williamstown”. After a few condolences, we leave them to their vigil.
Even weeks later, I cannot shake the feeling we could have given Audrey a better death. I regret not knowing what to say. I hope it will come with experience, the knowledge of what to say to comfort the fears of the ill and the dying without patronising them, or avoiding acknowledgement of the situation's gravity. Did I do well enough, in spite of my immaturity? I regret not removing her BiPAP mask. Did we deny a woman her independence and her comfort, in the last hours of her life? But most of all, I'm left wondering how this will all continue to shape me and change me. Will each patient's passing erode away at death's significance? Will there come a sage's enlightenment, the knowledge that without death, there can be no new life bringing a calm that nullifies the sorrow of loss? Or will each death keen, life-affirming in the great tragedy it brings, the intensity of emotion a confirmation of what it means to be human, to feel?
On uncertainty I must look back and with uncertainty I must move forward.
Failure brings no endings.
It has been enough, is enough, will be enough, to have tried.
Dr. Konrad Gunter