new year, same ol' me

Death is terrifying because it is so ordinary. It happens all the time.

- Susan Cheever

The last time I was on service was July 2010, but I'm back on the wards in the medical ICU and getting into the swing of things: the short white coat, the patient presentations, the constant questioning and learning. Minus the part when I almost passed out while rounding with my entire team - for no reason - and was force fed juice boxes by the nurses - and had to be put down to bed in the resident call room - and then sent home early. No big deal.

However, the death and dying part still takes getting used to. There have been many lengthy conversations with families about end-of-life care, hospice/palliative care and patient care goals. And every day, I'm impressed by the compassion and thought that goes into both the care we give and the manner we handle these painful and devastating situations.

But it's still hard.

On Friday, I watched an 80-something year old Air Force veteran take his last breath after being extubated and taken off of the ventilator. It was a packed room: a wife, a son and daughter-in-law, a second son, a brother-in-law, a brother, a nephew and a chaplain.

He was with us for about 9 more hours, taking in shallow ragged breaths, and surrounded by those who knew and loved him deeply. However, his weakened lungs and body couldn't muster the energy to overcome the work of breathing. As his wife of 50+ years stroked his liver-spotted hand, just like that, he was no longer with us. I had never seen someone actively dying and so I asked to be in the room with the palliative care nurse, who was administering the medications to make him more comfortable and ease his pain and anxiety.

I'm not sure what exactly triggered them: the prayers, the burst of grief from the stricken wife who had just lost her life's companion, the thoughts of my own grandparents and loved ones with health problems. But no matter how hard I tried to contain them, the warm tears escaped and rolled down from the corners of my eyes. Unsure if my emotional reaction was appropriate, I stepped out of the room to let the family grieve in peace.

Deep down, I hope the death and dying part will always take getting used to.