Friday, March 09, 2012

Death be not proud

A friend of mine is dying. We all are, if you really think about it, but she is doing it more quickly than the rest of us, and more painfully. When she was first diagnosed with cancer I got her a get-well card. Luckily (as I was at the hospital gift shop, which of necessity carries a panoply of get-well cards) there was a "support for long illness" card available: not a tweety, sunny, get-well-soon card of the type you'd give someone after gallbladder surgery or a broken leg. Now, with the extent of her illness known, I went to get another card, and found that none of them were really appropriate. There is no greeting card that covers the wide swath of terrain--the valley of the shadow of death, you might say--between "get well" and "deepest sympathies." The "deepest sympathies" cards, it hardly needs to be said, go to grieving relatives and friends after the fact. The reality, at this point, is that she will not be "getting well soon." Most likely she will not be getting well ever, at least in a physical sense.

As a medical student, I've been trained to do battle with death--to stave it off with pills and procedures, respirators and central lines. I know how to shock someone's failing heart back into a stable rhythm, how to plunge a needle into someone's chest to save them from a pneumothorax, how to (if need be) sacrifice a limb to save a life. These are part of the official curriculum. There is no official curriculum on engaging with death in other ways--on how to greet it as a welcome guest, coming to deliver a cancer patient from intractable pain; on sitting with a family and a brain-dead patient, waiting for it to come; on telling the parents of a child with cystic fibrosis or Tay-Sachs that death will be ever in the background of their tragically shortened lives. This is not taught in the classroom; it is something that is passed on, from one generation of physicians to the next, in the clinics and on the wards. As one of my neurology attendings told me, as we worked together on the pediatric consult service: "One of the most important things--and one of the things we often forget--is knowing when to have that conversation with the parents about letting a child go." This is the art, not the science, of doctoring. This, not anatomy or biochemistry, is the secret and sacred stuff of our profession.

Last night as I lay in bed, courting sleep, my mind wandered to this friend. I imagined her in her apartment, alone, and perhaps frightened. I thought about how she looked even a few months back, and shivered at the thought that the cancer had been blossoming like some malignant flower all throughout her body, and we had known nothing. I thought about her funeral, balked initially at the impossibility of it all--then wondered when it would be, wondered what the choir would sing--and I cried, for her and for all of us whose days are numbered. And then, unbidden, the beloved words of Donne's 'Holy Sonnet X' came to me, played themselves over and over in my head until I finally fell into a fitful sleep:
DEATH be not proud, though some have called thee
Mighty and dreadfull, for, thou art not so,
For, those, whom thou think'st, thou dost overthrow,
Die not, poore death, nor yet canst thou kill me.
From rest and sleepe, which but thy pictures bee,         5
Much pleasure, then from thee, much more must flow,
And soonest our best men with thee doe goe,
Rest of their bones, and soules deliverie.
Thou art slave to Fate, Chance, kings, and desperate men,
And dost with poyson, warre, and sicknesse dwell,  10
And poppie, or charmes can make us sleepe as well,
And better then thy stroake; why swell'st thou then;
One short sleepe past, wee wake eternally,
And death shall be no more; death, thou shalt die.

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