A View of Life at its End

Who and what will you leave behind?.

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We are all going to die. It sounds dramatic, even ominous, but nothing is truer. Nothing else completes the human experience. Although I’ve lost loved ones in my life, it has been my years as an intensive care unit physician, often responsible for delivering grave news, that compels me to frequently contemplate death. There is no formal training for this, yet for an ICU physician it is all too common to find your best gift of service is guidance for patients and families when a life comes to its end. It’s impossible to anticipate the reactions of loved ones in the wake of bad news. Decisions are slow to solidify when juxtaposing the struggle for life with the acceptance of death. Over the years, I have been hugged, screamed at, threatened, and sued.

There is one family I remember more than most. This time, I was asked to join at a patient’s bedside where family held hands sharing stories about the young woman. She was dying, sedated, and on life-sustaining machines. As she lay before us, their remembrances led to eruptive laughter and gut-wrenched sobbing. I could not have imagined a more beautiful tribute, a more poignant soundtrack, or a greater privilege than their invitation.

In such moments, stories are adept at reflecting life in the context of death: A husband crying for the bride he loses after 50 years of marriage, a marriage ended by bleeding in her brain. A terminally ill 52-year-old grandmother with respiratory failure begging not to be put on a ventilator because of her profound anxiety after watching her own mother die in a similar way. A 23-year-old leukemia survivor dying because an adverse reaction to medications left her needing a lung transplant she will not survive to receive. Even for physicians skilled in end-of-life conversations, it is impossible to witness these scenes without contemplative self-reflection: a constant flipping-through the mind of one’s own cherished or strained relationships.

Seeing an old man mourn his wife of 50 years, I feel relief to be unmarried, avoiding the tangible grief of losing a beloved spouse. Yet I also long for the deep-rooted love that comes with experiences shared over a lifetime. Seeing family gathered around a dying child, I wish my family could reconcile to stand in a room holding hands, and I am grateful for the chosen family of close friends I have accumulated over the years.

Naturally, I wonder at whose bedside I will stand and who will stand at mine. Yet, unexpectedly, in my attempts to guide others moments before death, my patients have offered me greater guidance for the course of my life. We may see life more clearly at death, but the perspective gained from patients leads me to think we should seek that clarity now. Paying tribute need not wait for death, for we all live first. It sounds dramatic, even idealistic, but nothing is truer.

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