What We Talk About When We Talk About Death

My involvement with death prior to intern year was sparse. I had only experienced death from afar. My grandparents passed away at varying points during my childhood and adolescence. I lost a friend to suicide when I was in medical school. Another was struck and killed by a car in college. I was not involved in the process of these unfortunate deaths. All of them I had to find out very much after the fact. I did not witness their deaths and I was unable (and, at the time, unequipped) to intervene with their deaths. What I knew of death prior to my intern year was only the emotional impact of its finality. Only the sorrow. I had no idea what “coding” someone meant, nor what some of the outcomes were when the medical community is able to “bring someone back.” My relationship with death was one of aloof fear and avoidance. It was a concept I’d rather not think about nor confront. Until I had to…

The first time I experienced death from the other side was my initial rotation as an intern in the ICU in July. There is a constant anxiety that sits inside you as a fresh intern, a worry you forgot to do something, a concern you are not pulling your weight, or worse that you are messing up. The constant anxiety and never-ending tasks to complete are at odds with your inexperience and lack of time. All of this creates a mental haze where other real-life concerns seem to become less important. And then, through that haze, you hear it: “CODE.” Being apart of the process, having a role, a purpose helps you cope with the immediate horror that is unfolding. Unlike my experience as a med student in a similar scenario, the role of intern is to actively intervene and in doing so, your mind does not have the chance to grapple with the emotional dread of what is taking place. I think it is only after when these feelings sink in. It is a defense mechanism of sorts because the alternative of breaking down at the moment would make it impossible to do this job. Nonetheless, it feels odd, like an out of body experience, suspending your natural humanity and allowing the adrenaline to take the wheel. And then there is the repetition. Seeing it again and again. The training kicks in each time and my mind goes off to that other place, blocking out the gravity of death. Aloof fear. Avoidance.

I think these micro-traumas build up and sit with us. They should. Another human being’s passing should affect us. Yet, this is why is important to recognize these feelings and acknowledge them. Dispelling the stigma about death and talking about it is key. It is key to self-care, preservation, and continuing to live and deliver care with a healthy mindset. It also allows us to speak openly about death and dying with our patients, their families, and amongst ourselves.