Death and Mortality

As Chen writes in Final Exam, death is one of the most common experiences that physicians are not prepared for. I appreciated her completely open writing, and found that my own thoughts and experiences with death mirrored hers. Like her former medical student self, I have little experience with death, but am realizing that it is something I will deal with more and more as my family and friends grow older.

One of the medical student’s first experiences with a dead body is the anatomy lab. I have heard stories before about medical students moving from uneasy respect to nonchalance around their cadavers, developing affections like naming them, or what would seem like insults, like playing football over the bodies. This indicates that there are many responses to these cadavers, which are the manifestation of death. I found it interesting that Chen reconstructed her cadaver’s life through dissection. It is nigh-impossible, and perhaps not desirable, to overcome the empathetic instinct of trying to feel for a patient’s life story. Chen was attaching herself to her cadaver even though, as she writes, doctors are taught to exhibit “detached concern, secure uncertainty, and humanistic technology.” These descriptors, while they might seem to describe ideal clinical standards, are incredibly difficult to learn, and are truly ideals that medical students undershoot and overshoot until reaching some semblance of equilibrium. There is an illusion that all doctors can indeed be clinically detached, and when it comes to an issue as sensitive as death, this illusion can be difficult to maintain. Along with this notion, there is the expectation that a doctor, in being able to save lives, also has command over death, which is not true. Doctors struggle to reconcile external and internal expectations of being all-powerful medical professionals with the inevitability of death.

Similarly to Chen, I think that I have conceived of death as something mystical, that defies ordinary description and has an air of solemnity attached to it. It is a “big deal” as Dr. Israel writes in her New York Times piece, that doctors have to face on a weekly, if not daily, basis. Like many things, with repeated exposure, death can lose meaning, and a medical student might develop the coping mechanism of treating it as if he didn’t care, or even derisively. I wonder if doctors might have something to learn from the therapeutic methods that other groups of people who witness death teach. Doctors have the unique position of being the caregivers, the ones held responsible for a patient’s life or death, but could they learn from the experiences of nursing home workers? Soldiers’ accounts? Residents of neighborhoods with high homicide rates? One of the most powerful works I have encountered that explores the concept of death is All Quiet on the Western Front. While violent death by barbed wire is different from death on the operating table, I think it is the powerful idea of someone’s innate spark fading from existence that we can look at as some kind of shared human understanding.