Tag Archives: death

Kacper Niburski is a medical student in the Class of 2021 at McGill University. He is also the CMAJ student humanities blog editor.

 

 


The heart is open and I wonder if my feet smell. Much of the room seems too busy to notice. The surgeon is making a joke about the shaky season of the Toronto Maple Leafs. The attendants laugh in unison. The perfusionists look to their dials, turn one, turn off another, and gaze my way with a nod. Do they smell it too?

Two hours earlier held no scent. The morning swam with sun. I arrived early to the Hospital to shadow the lead cardiac surgeon. I was told via email to dress light. To arrive early. To be ready.

I was. The night before saw me donned in recycled papers of anatomy, reviewing structure after structure, medication after medication. Any heart sound I’d be prepared to listen to knowingly. Any condition studied could be recited as though from a pleasant dream too pleasurable to forget.

I try to share that pleasure now. I smile back, failing to remember that my face is blocked with a mask. My clothes too have been changed. I am adorned in green, a naïve look against the shadow of yesterday. Only my socks stick out of their wrapping. They look like a left-over meal stuck in a fridge too long.

The surgeon makes another joke. Another chorus of chuckles follow. Blood is pooling out of the myocardium. “Suction please.” The whirl drowns out the sounds while the heart suffocates with air.

When I met the surgeon, I seemed to do the same. I whispered my name while shaking his hand. Then I sat quiet while the cardiologists spoke. The case was difficult. The 42-day old child had a type b coarctation, aortic stenosis, and now, only presenting the day of the surgery, a hematoma. One as large as the left ventricle. One as large as a life.

What would you do, the surgeon asked a cardiologist in the room. I am not sure, she replied. In thirty-one years, I haven’t seen anything like this. That shit is scary. The black mark on the screen seemed to absorb the light and the conversation. They all stared at it in silence.

The OR bursts in another bustle of laughter as the extracorporeal membrane oxygenation begins to tumble. The heart now pauses to a near standstill. Each beat appears forced, slow. I take twelve breathes before each one. I take another ten sniffs. The smell is getting stronger. I take nine the next cycle. Stronger yet. Eight the one after.

Meanwhile, the hands heave life. The surgeon is busy cutting and stitching and suturing and joking and cutting again. Bits of flesh fly into the vacuum. One hour passes. And the smell only worsens.

What could it be? I changed my socks. Washed my feet. My boots were new too. But in the morning, one of the cardiologists told me I could not wear them. Salt ate away at their integrity.

They were not allowed in the OR. You’d have to go in your socks, he said. He was wearing unblemished leather shoes.

With them, we walked to see some of his morning patients. Each case was riddled with complexity. Dr. K, is the heart rate stable? Dr. K, what was the correct dosage applied? Dr. K. Dr. K. Dr. K. His name was called everywhere while I stood beside him like a lost dog. My name was not asked once. Only until after my feet hurt and I was lost in a stew of medication names was I called. Kacper, I was told, this is the room. This is the patient who will have the surgery.

The room was thick with a deep, hugging black. The parents were huddled over a small incubator. From the doorway, they looked like stars.

The light of the OR is aggressive now. It weeps it. I think of them and that idea – the family as stars, celestial bodies watching the world. At first, I was comforted by it. I was brought back to period faraway from this standing where I was sitting in a canoe, trees whispering around, unshoed like I am now, and looking at a universe that could not look back. I could recognize the beauty. I could become it too.

But now, standing on my toes, trying to get a better view of each slice, watching as the screen is tipped forward and then away in a window of opportunity no larger than bundle of grapes about to ripen, I am reminded that stars are long since dead. They are no more. Only their light is forced to stay. The heart hasn’t beat in a while.

What will happen? I try to think, but I am nervous. I shift heel to heel. The wrong facts come back from the bridge to yesterday’s nowhere, to when I studied under the silence of a life. Move around, excite the sympathetic nervous system, get more blood from the heart, heat the body, sweat more. I spell out the conclusion once more in my head.

I try to stop moving in a dry attempt at survival, but these simple watered-down facts make me more anxious. Maybe the smell is me, I begin to think. Maybe I have reached a threshold of no return. Maybe I cannot stop sweating now and I will become a pool of water. First at my feet. Then my knees. I will get shorter and shorter, soon seeping into these white floors, climbing up the exhaustion of a lifetime, extinguishing these expensive machines, filling up the closed room in a smell that cannot be avoided now, that was all that was, all that is, all that will –

I am tapped on the shoulder. Dr. K asks how I am doing. I tell him okay. Pretty interesting, eh? Absolutely, I answer in what I imagine sinking sounds like.

 


Note: This is a work of fiction. Any resemblance to actual people, living or dead, is purely coincidental, similar to how a flower described here would not smell as good as the real.

Arnav Agarwal is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!

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Shubham Shan is a medical student in the Class of 2019 at the University of Toronto

 

She arrived on an inclined stretcher, grasping her Venturi mask like a child holding on to her favourite toy. Flanked on both sides by paramedics, her eyes were splinted wide open by shock and her chest heaved up and down rapidly. She was a queer shade of purple — like spoilt red wine diluted with water — and her gaze flitted around the emergency department as if looking for someone familiar. The paramedics passed her off to the doctor then left, shaking their heads. I remember watching the doctor take the patient’s puffers. The patient swore loudly and snatched them from his hands; first the orange, then the blue. She cocked the puffers like guns, inserted them into her mouth, shot the mist deep, and inhaled. She coughed for what seemed like an eternity. She was what we called a “blue bloater.”

When I saw her again, she was lying on a tattered mattress with bright blue sheets in a freshly bleached acute care room in the emergency department. Her condition had gotten much worse. Her abdomen caved in paradoxically whenever she breathed in. Her eyes were bloodshot. Every time she exhaled, it sounded like an infant's rattle. ...continue reading

Beatrice Preti is an Internal Medicine Resident (R2) at Queen's University

 

 

 

The list is long, but I know your name
Each day before, its spot was the same
Second from the top, the second room on the right
The one with three windows and a broken bathroom light

But today something’s different; the list I have’s bare
I looked for your name, but it wasn’t there
Something has happened, and, in my heart, I know
That though I fought to keep you here, you found a way to go ...continue reading

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Jenna Webber is a Public Health & Preventive Medicine Resident (R2) at Queen's University

 

It’s 1 AM. The call comes in: VSA en route. Your team assembles.

Efficient, empathic, skilled — the team prepares for arrival. Roles are assigned, facts are reviewed, and questions are posed. The team is ready. You wait.

The patient arrives. Pulse check — asystole.  On to the chest. Transfer the patient to the bed. The team knows what to do — whether through simulations or past cases, everyone knows the algorithm. Everyone knows their role. With heads, hearts, and hands, everyone works on.

The clock marches. Tick. Tock.

 The skin is mottled. Bagging is going well, but intubation is tricky. Paeds and Anesthesia are on their way. Keep bagging. ...continue reading

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Michael Gritti is a medical student in the Class of 2019 at the University of Toronto

 

 

“To induce asystole as needed.”
Looking the decision in the face
wasn't as simple as I'd thought, I conceded.
But, simply, was it right? Was it just?

Eighty millimoles of potassium chloride: ...continue reading

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Dilshan Pieris is a second-year Masters Candidate in the Health Science Education program at McMaster University

 

When Breath Becomes Air
(Random House, 2016)

When Breath Becomes Air begins with Dr. Paul Kalanithi’s childhood life in Arizona, where he developed a passion for English literature and biology that provided the foundation for his desire to pursue medicine. During the first half of the book, Dr. Kalanithi writes about this journey, which notably involved attending several internationally-esteemed universities:  Cambridge, Yale, and Stanford. Not only did he graduate from these schools with honours — he was also pursuing the notoriously demanding specialty of neurosurgery. Despite the rigour of residency training in this discipline and a blooming relationship with his partner, Lucy, Dr. Kalanithi was not merely managing; he was gradually rising to prominence in the field as a clinician-scientist. ...continue reading

Beatrice Preti is an Internal Medicine Resident (R1) at Queen's University

 

 

 

It was the strangest of days when I met him first
Everything jumping from awful to worse
People were shouting and crying and seizing
Coughing and choking and retching and wheezing
It was nearly twelve hours before I could go home
But the attending doc called direct on my phone
And asked me, please, could I see one patient more?
Well, I couldn’t say no, so I went back to the floor
And met him there, though, then, he was alive,
But looking so dead I knew he hadn’t long to survive
Yet I took the history, and wrote everything thing down
Signed the orders, made the calls, and finished my rounds
Tucked him in for the night, and was just about to leave
When he said to me, “Doc? How much time do I have, please?” ...continue reading

Sahil Sharma is a medical student in the Class of 2020 at Western University

 

Nearing the end of my first year in Medical School, I am amazed by the wealth of knowledge acquired during such a short time. There have even been several moments throughout the year where picturing myself as a fully licensed physician seemed slightly less daunting. I have become comfortable with routine physicals, certain diagnoses, different drugs, and management of a wide range of illnesses. I have no doubt I will encounter each of these facets of healthcare during my career. However, there is one unavoidable aspect of medicine that has been discussed very little: death.

The discussion of death is, understandably, quite sensitive; thus, discussing it with such a diverse demographic of students requires a certain amount of skill and reserve. But after learning about concepts such as palliative care and patient-physician relationships, it seems unjust to gloss over one of the most vital roles of a physician — the ability to comfort patients in their most troubling times. ...continue reading

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Zeenat Junaid is a medical student in the Class of 2020 at Bahria University in Pakistan

 

“How do you make leukemia visible?” Jo Spence asked herself.

A British photographer and educator, Spence was a transforming voice in the arts of the last century. Her documentary-style photo albums dealt with themes of class struggle, conformity, and feminism. In 1982, she was diagnosed with breast cancer. A few years later, leukemia also set in. This cancer was not just in her blood and bones — it had seeped into her existence. It hijacked her arteries of security; it exiled her into grey plains of isolation she had never known before. Her whole career, she had sought to catch that special look — that nuance in a scene that told another story. But could she capture this tyrant phantom of disease now in her photos? How to express something for which words falter? ...continue reading