By Roshni Kakaiya
February marked one year since I last saw somebody die in our hospital surrounded by their loved ones. To give you some context, I am a physician in training in the South Bay — a community that was hit particularly hard by the novel coronavirus that can lead to COVID-19. As a family medicine resident, I take care of patients in our clinic, admit them to the hospital, care for them in the ICU, and even deliver their babies. As such, I am no stranger to the never-ending cycle of birth, illness and death, especially during the pandemic.
Yet I can tell you that a few moments of clarity shine bright against the haze of this past year. This memory of my patient’s death stands out so strikingly to me because of the comparison with what came down just a few days later, when our lockdown began and our hospital policies changed.
One year later, I can close my eyes and still picture this patient and her family. The patient was in her 80s and the matriarch of her family. The day before she died, she had woken up with some energy and was able to speak with her daughters who were at bedside most of the day. We see this sometimes in the days before people pass — they get a burst of vivaciousness that sometimes fools us into thinking they are doing better.
The day my patient died, her daughters were holding hands and all touching some part of their mother, grieving together and comforting each other. Their husbands and children were somberly in attendance, intermittently wiping away tears. There must have been at least nine people in that room, something I can barely imagine now with our limited visitor policy. The daughters sang the patient’s favorite hymn, and they were even able to play part of a sermon their mother loved. Every time I walked into the room to check on this patient, I immediately felt the warmth, the love and the comfort the family was bringing to each other. This was a good death. This was a death filled with love, and touch, and warmth, and solidarity, and connection, and presentness. This was a death the family could remember and discuss as needed as its members mourned, which, as we have come to know, is crucial to processing such a significant event. This was a natural death of a woman in her 80s who had lived a long and wonderful life.
As a physician in training, it initially felt counterintuitive how much time we spend thinking and talking about death with our patients in both the hospital and clinic setting. However, I’ve come to realize that some of my most important work comes in the form of advocating for my patients to have a good death. A death they would have wanted, maybe even that they could have chosen for themselves — a peaceful death or a death with a fighting spirit up until the very end.
As I see our patients dying mostly alone in our hospital, with only family being able to visit, one or two at a time in the hours before a person is about to die, or looking at their loved ones through the window as they are intubated and sedated, I grieve for our community. I grieve for those who have had so many good deaths taken away from them — and had them instead replaced with a screen from which to watch their loved ones slowly dwindle away. I grieve the good death, the death that comes with a natural closure. Yet I am hopeful that one day we will return to this good death — the death that is filled with touching, hugging, crying, laughing, and snot flying everywhere. One day, togetherness will not be the vector for more deaths and more grieving. It will be the balm that heals us from the most difficult year of our lives. This is the death I wish unto you and your families in the future: the good death, a death worth dying for.
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