Death

For 2 days in our Family Medicine posting, we have a palliative care programme, where we are exposed to palliative medicine, visit a hospice and make a house visit to a patient requiring palliative care (both to be done tomorrow). To get us to think about certain issues, we were shown this movie - "Wit", starring Emma Thompson. Powerful it was, to the extent that some of my male classmates teared at the end.

Essentially, the movie depicts the journey taken by a literature professor from the moment she was diagnosed with advanced metastatic ovarian cancer, to the point when she passed away. Not only did it give me a glimpse of what a terminally-ill patient with cancer goes through, it also exposed, albeit exaggeratedly (hopefully), some short-comings of health-care providers and (supposedly) professionals. As much as professors in medical school and doctors in the hospitals belabour the point that one must view a patient as a human and as a whole, how easy it is for us as medical students to view them as 'interesting cases' with good histories or physical signs to elicit; and possibly as doctors in future to look at them as diseases to be managed and treated, instead of people whom we should be caring for holistically.

There was this particular scene when the doctor was just shooting questions at the patient, some less relevant than others, showing no concern or interest to her as a person, in the process of clerking her. I laughed. How ironic in retrospect, when I realise that sometimes, this seems to be the way I'm clerking patients at times, especially when time is short, and there are many other patients to see. I asked myself, "Is this who I'm going to turn out to be?" I pray not.

A dying person loses many things, as brought up during the discussion after the movie.
One loses his physical appearance - hair, eyebrows, etc.
One loses the roles he used to play - the one being cared for, instead of the carer; the one being provided for, instead of the provider; roles at work and in the family.
One loses freedom when one is hospitalised - Fixed timings for meals, medications and bedtime; having to wear the same garb as everyone else; having to do what the doctors, nurses, therapists tell you to do (and you can't really say no); having your movement restricted within the confines of the hospital.
One loses independence.
One loses control - not only of his situation, but many times, of his body.

One risks losing his identity if his identity is dependent on the people who used to surround him.
One risks losing his value if his value is based on the work that he used to do.
One risks losing his self-worth if his self-worth is established based on the roles he used to perform.

There is only so much one can hold on to at this stage. Some people are motivated to live their remaining days doing something meaningful. All very well. But what if one is so weak, to the extent of not being able to do anything, what is going to sustain him till the day he has to go?

If one must look for something to hold on to, it had better be something that never changes, and that can only be one thing - that God loves you, and you are His beloved child.

"Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;

One short sleep past, we wake eternally,
And death shall be no more, Death, thou shalt die.
~ John Donne, Holy Sonnet X

Life, death, soul, God, past present. Not insuperable barriers. Not semi-colons. Just a comma.