Declaring Deaths and Spreading Joy : Both on My Job Profile

Dilemma of a Young Doctor

Dr Neharika Niraj

I am talking rapidly in the set dialogues yet it seems her eyes are talking to me faster than my voice is reaching her. It is quiet except for the beep beep of the monitors yet it seems like her eyes are shouting at me.

“Tell me he is fine. Or Tell me he is dead.. But just get done with the preliminary rubbish fast” her eyes are imploring. My eyes must be saying, “forgive me, but I have to be kind when I am breaking this sort of news even though it is routine for me and life changing for you”. But of course, she is looking at my mouth and not even looking in my eyes.

Ill be recounting the details to my family later.

FLASHBACK 1: I remember asking my brother to check my final MBBS result. When he called back and started off with the usual things people say to build up a situation my heart was beating hard. It is one of those moments when you want the other person to tell you fast; you cant bear the uncertainty and you want to feel relieved after good news. It is one of those moments when you want the other person to slow down and take some time because you want to pause life for sometime before hearing the bad news

FLASHBACK 2: My sister has called me crying just once in her life. And I vividly remember praying silently, dreading what she has to say. I needed time to prepare myself to hear what she will say.  Yet I wanted her to speak as fast as possible, I could not bear it. She was crying because she scored few marks less than she expected to. I understand she had worked hard, but I also understand that her marks were awesome. Toppers, really.

So here in the ICU of our hospital I am probably giving the patient’s wife time to prepare herself for the words that will change her life for worse. And then, I apologetically tell her that her husband is no more. With the necessary yet ineffective gentleness. With the compassion which is more professional than personal, but with kindness that is genuine. I saw shock, denial, fear, brief acceptance and numbness flash across her face in seconds. Who says these stages occur after weeks to months?

So how is life when you have at some point of time routinely declared deaths?

I remember my first and that is the one I remember clearly.

I as a new intern, very eager to save lives even though  there was hardly any opportunity at that stage , was trying to get a patient shifted out from a private vehicle to onto the hospital stretcher. I felt someone tugging my sleeve and pointing sadly at the man’s face. The dead patients face. I stopped in my tracks. I had never looked at a fresh dead body so up close. It took an older and much senior nursing staff to softly nudge me to remind me that I am the boss here. Half my fear was due to the proximity to the body and half due to the fact that it takes some confidence to declare a man dead. To declare to his kith and kin that your life is changed forever. I felt important, responsible, sick and sad all at the same time.  I checked for the heart rate. I pushed in the ear plugs of my stethoscope so much inside the ear that I was risking a tympanic membrane rupture. I checked the heart, the pulse, the pupils, the corneal reflex and everything that could conceal some sign of life. Finally I took a deep breath and did it. I think I became a couple of years older at that moment. Probably I devised defence mechanisms quite fast because in full honesty, I don’t remember the second death I declared. Or even the last.

The one which scared me after many years? Young girl rushing in emergency with fear and panic written all over her face during my residency days. A stretcher with a man in forties. Quite obviously not alive. Some years of experience tell me that it has been some time since he died. We do the needful promptly even though there is no hope. After clinical assessment and a straight line ecg for documentation I tell her. I break it to her very clearly.  The daughter. I was not sad. Not because I was not sad. Because I was afraid of this girl. And that overpowered any other emotion I might have had then. She pushed me hard and said “Are u mad’? I held onto something for balance as I saw her running past me to clutch the body. I felt sorry, extremely sorry for she lost probably the most valuable person of her life. I can describe her face to  a portrait artist today also and he could draw a replica of her face. I can still hear that “are you mad” ringing in my ears if I recall today.

The ones which are easiest to declare? The ones where a distant relative and the close family start alternating to take care of a 80% burnt person. They did not expect her to survive even two days. It has been seven days. As soon as you tell them they nod ok and point to the skies with folded hands. Telling me that after all it’s the God’s will. Because there is less sadness or shock on their faces, I tell them that they should collect papers from the sister after sometime. I know they want to know the procedure. They are not caught up with the bad news. Cruel? I wont be so judgemental. They have seen their loved one endure misery for seven days.

Back to ICU ; The ever happy and talkative, mostly pleasant sometimes annoying “Samar”  enters the duty room. He plugs in his charger like it is his room and not mine. That breaks my chain of thought. He is a BVG worker. In case you did not know BVG stands for BHARAT VIKAS GROUP and that is an integrated company providing house keeping workers to different sectors. My knowledge of this comes after searching online for BV workers endlessly. Because I thought It is BV ji. Like sister ji and doctor ji.

His happy presence is a strong reminder that despite the bad news I break, I spread happiness too.

Kulwinder in 2010: emaciated young skin man with necrotizing fasciitis of chest wall. That is a deadly disease that eats up living tissue. He was bed ridden with bulky dressing. As a first year Surgery resident I was supposed to change his dressings thrice a day. Dressings took half an hour every time.  I did them sometimes happily, sometimes grudgingly. Sometimes missing meals, sometimes missing sleep.

Kulwinder in 2013: it was my final year and I was having breakfast. That is a luxury you deserve afer a couple of years as a resident. You move on from glucon D biscuits and chai to actual breakfast. Someone taps my shoulder. As I angrily look at the tall robust sikh man with a leather jacket and boots comtemplating what swear words to use, he grins. And my heart melts

Being an all time dominoes fan when I open my door to find sandeep, dominoes delivery boy.: Cant help but smile when I realize that I am one of the very few people who know his blue dominoes jacket is hiding a permanent colostomy. Colostomy bags I have changed often. He discovered a new lease of life and I got some extra oregano seasoning packets. Small token of affection from Sandeep who came almost gasping for breath after a bad road traffic accident one year back.

So there. It is declaring deaths sometimes. Sometimes it is staring at your fruitful efforts in wonder. And it is all routine. ☺

Dr Neharika Niraj MBBS , MS ,MCh, DNB   is a Consultant Plastic Surgery 

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