Rituals

I think I need to develop some personal ritual, small as it might be, to mark a person’s death in a respectful, if seemingly insignificant way. I decided this today in light of a patient who passed away on my ward today. I wasn’t directly involved in his care and since I wasn’t, I saw a little bit of what an outsider might see for a change. The door often closed. Nurses being reluctant to go to his room, some less experienced ones anxiously asking about treating fevers, giving oral medications, etc. Even I was reluctant to barge in because I hadn’t been involved in his care directly and didn’t want to shove yet another unfamiliar face into the lives of grieving family members. I can see how, on a ward full of demanding patients, how easy it is to visit less often the patient who is desiring no interventions. As a resident responsible for 5 patients, and having to cosign all the orders, labs, etc, for my medical students other 10 patients, it is easy to spend less or no time in patients' rooms requiring the totally different kind of care that is palliative care. That’s why palliative care is such a unique and special field that requires separate wards in hospitals. No curative treatment does not mean no treatment. It is work I love to do and yet today, I feel that I let myself down as I felt like I didn’t have my palliative care hat on today, that perhaps there was something I could have done/said to help the family deal with this loss. The team has been great, and I think they did keep him comfortable in a private room, far less hospital-like than a big hospital. But his death has me thinking, about him, about palliative care and the challenges of providing it in an acute treatment or rehab setting, and about how I can mark a patient’s transition in a way that helps me to process and pay my respects to each person that I’m involved with that dies. And I’m not sure if there will be one ritual that unfolds. Perhaps each person deserves some reflection and it will bubble up how to best mark or process their death.

In BC, the first patient I had that died did so after a surgical complication on top of already being very sick with multiple diseases. I didn’t really know him, and felt at a loss for words as I saw him in his ICU hospital bed after the second repair surgery. He had no family or friends around and no one was speaking with him since he was apparently unconscious. I wanted to say something profound, or meaningful, or helpful, or ??? I was stumped. Finally I entered the room, held his hand and said the only thing that came to mind which was “Mr X it’s me, the med student. I just wanted to say that it’s been my pleasure getting to know you over the last few days. I’m so sorry you’re so sick. I wish you all the best.” I know, even as I write it it seems ridiculous. I wanted to say something epic like they do in movies that would fill him with a sense of wholeness so that he could move on, but nothing like that seemed appropriate given the very limited nature of our relationship. And ultimately, I just didn’t want him to feel alone, devoid of anyone talking to him in his last few hours. They say that hearing is the last sense to leave us when we’re dying -  I don’t know who it is that says this (and don’t care) but I think it is sage advice for families & friends of loved ones), and I think if you have the opportunity to fill someone’s last few hours with kind words, so much the better.

So yes, I think I’ve settled it. There will be no “one ritual fits all” approach for me, rather I think I’ll be tailoring my goodbye to the person, the situation, the impact they had on me and to reflect the relationship I had with them. Goodnight & goodbye, for now.