Waiting in the Emergency Department for a call today, I watched a 84 year old woman come in with complaints of difficulty breathing and eventually deteriorate over the day from alert/confused to dead.
Her family was there the whole day, sitting in steel fold-out chairs at her bedside, rubbing her head, fixing her hair and watching the monitor intently. O2 saturation, they were told, was the number that would effectively chart their loved one's progress- and the number went downward all day. From mid 90's, to 80's, 70's, and eventually zero.
The family seemed to have an understanding of what was going to happen today, but it was upsetting nonetheless to watch hopeful attention gradually degenerate into helpless waiting. This sister, this grandmother and parent, was a DNR. She had made her decision about this day long ago, when she was lucid, and there was nothing much else to do other than sit and watch. I brought the family coffee and asked if there was anything I could get them. They shook their heads no and thanked me. Everyone here is so kind, they said. They were glad that this is the place that "this" would finally happen. They knew.
When it finally did happen, the reaction was sullen and repressed. One of the women let out a few sobs into a wadded up napkin. An older man held her hand and shook his head. At least this is what she wanted, he said. It was time. She had been sick for years, wavering on a razor's edge between life and death. This is a good thing.
I helped bring her body down to the morgue. The family now gone, we lifted her up by a sheet onto a steel stretcher and attached a curtain above supported by posts on all four corners. Another thick sheet hung over the aperture, providing a square-like appearance that betrayed no clue as to what was underneath. This was better, the tech said, so that people didnt get upset knowing that a dead body was rolling through the halls.
Entering the morgue sent a shiver down my spine. It may have been from the 40 degree chill inside, but it shook me to see the five bodies already there lining the wall each on their own cart and covered in thick zippered sheets. The shapes were amorphous, only head and toe were distinguishable. The tech brought our cart next to an empty spot, and tipped the stretcher sideways so that the woman's corpse rolled out onto the cold steel. No gentle lift with the sheet this time, the family was far from view. The old woman lay there still, her head cocked back and mouth locked wide open as if frozen while taking her last dying breath. She was small, maybe 60 pounds. I helped get her into the zippered sheet, and looked away as the covering was wrapped over her face.
Concealed, this woman that was alive a few hours ago looked indistinguishable from the rest of the corpses lining the walls of the frigid morgue. Removed from her loving family, this old woman was now nothing more than a body: a new task that the morgue workers had to add to their lists. As we rolled our empty stretcher out of the silent room, I heard a groan from the man behind a nearby desk. "Another one, huh? I'll be dammed if I'm going to get out late cause of this."
I dont blame anyone in the morgue. I dont think it is possible to see death like this every single day and be able to maintain the level of respect and somber silence that an outsider might expect. Even the most cataclysmic event, the sharpest of pain is dulled by relentless repetition. We still have to be able to do our jobs well.
I wonder though, how many corpses do you have to see before it no longer matters? At what point will exposure to pain numb me, blunting empathy and revealing only mechanical taskworking? How important is it that I feel for my patients? Does it even matter if I notice emotion, or is my only job to start IV's, shock, and push drugs? How can I continue to do this job for any length of time, and still care?
On the wall of the morgue etched into a wooden plaque is a plea:
Let conversation cease, let laughter flee.
Here is the place where death delights to help the living.
I'm not sure that this would be the same job if I didnt care.