Living and dying

"It is better to go to a house of mourning than to go to a house of feasting, for death is the destiny of every man; the living should take this to heart." - Ecclesiastes 7:2

The times where death is in your face. I dug up a few entries from the old blog. The time we heard about the death of our high school classmate, not long after his 21st birthday. Although we weren't close, I knew his birthday well. We shared birthdays. Knowing that this car accident could have been any of us, made us think about the fragility of life. We visited the graveyard. My sister, four years old at the time, came along. I asked her, do you know what it means to die? She shook her head and said uh uh. She asked whether people get dirty when they're buried. I think she knows a little more now. She points out dead rats in the garden to me. She said to mum that she felt sad there when the family went to visit grandma and auntie's graveyard.

Eight years ago, the year dad remembers well. Being whisked away in the middle of high school to be by grandma's bedside when she had metastatic cancer. How I cried when I heard over the phone that she was in a coma. When we visited her, maybe she had a few lucid periods, maybe she teared when she saw us. Surprised that, walking out of the ward, one of the doctors in a white coat was my aunt. Later in the year, the same aunt who had long standing system lupus erythematosus, who was actually supposed to be dead when I was a toddler from bacterial encephalitis, died from bowel perforation after a month in ICU. My cousin was just over ten.

A month before you got sick I called you for the first and only time, on my own accord, with mum's international phone card. You sounded sleepy from your afternoon nap but you were so excited to hear from me. You were always very excitable, and silly. You bought me pretty clothes, and I still have them archived somewhere. I think in the older generation, you're the only one who draws, and you drew brilliantly. How could you, you missed my lovely sister by half a year. We included your name in one of my sister's Chinese name characters, and maybe she's a little similar to you. These years, I want to tell you, hey I'm studying medicine too. Like me, was your decision a last minute one too? After you died, I had a vivid dream where I met you but I woke up and realised it was just a dream and I cried. I don't think often about you, but I had a less vivid dream about you this year, and felt sad again. The first few anniversaries, the family sent emails, poems, reflections, in remembrance. Time passes, grave visits happens less, and this year is the first year that we didn't receive these emails.

Seeing death is an inevitable part of clinical school. The man last semester, who grew progressively worse from his renal failure after making the decision to stop treatment. Shadowing the palliative care consultant last week, we saw people who were alive and walking, but barely. Off colour, thin, in pain, and very tired. Without the spark in their eyes, as mum put it. The grief of the crying daughter, the concerned husband - I see their pain, and I feel incredibly sad. I see the non existent boundary between them, and us, the professionals who give an air of being immune to the infirmities of mortals. And it scares me (the process, the grief, less so death itself). I started medicine thinking, I would care, but at arms length to be able to perform the job properly. I'm not sure what made me think I would be able to do that. Sure, it's easy to switch off the emotional connections altogether, but that doesn't seem right either.

Later in a tutorial, we talked about confirming death and communicating death to family members. Would you talk to the dead person while you perform the physical exam to confirm his or her death? Our group giggled. Like a friend said, we do laugh and joke about death to be able to talk about it. The tutor asked us to say dead, D.E.A.D. She gave amusing examples of how euphemisms can cause confusion with people from different cultural backgrounds. A dead man's son who asked for his father in the hospital, after getting a phone call from the staff that "he's passed on". Since his father has moved to a few different parts of the hospital, the son had thought the father had just passed on to a new ward, hmm awkward. Another story was that of a family who were confused about the treating team coming around saying solemnly "it's only a matter of time", every day. A matter of time til what? They wondered.

Back to the verse at the start - why would a house of mourning than a house of celebrations? Knowing the endpoint sets clear direction and priorities for living. But I'll direct you to the writings of another blog writer to think about that verse.



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