You are nothing but a collection of days, once those days have passed, so will you– Hasan AlBasri

For anyone in the health field, death is an ever present theme. Like a hidden antagonist, it lurks in the shadows, sometimes striking when least expected. It is an unfortunate daily occcurence for patients to expire in the emergency department, yet a young and healthy person suddenly taking a turn for the worse is not uncommon either. As Muslims, we are constantly reminding ourselves of death. Not because we are morbid species, but because like all genuine and true fears, they need to be acknowledged and dealt with head on. During my month rounding on the pulmonology floor, I watched 3 people approach death in different scenarios.

It was the second week of our rounds on the floor, and like most teaching hospitals, the attending physician and residents change every other week. We made our way down the hall, stopping by each room and giving the new members of the team the updates and a quick bio of each patient.  Once we reached the last room of the west wing, we entered the room, spoke to the patient, and watched as the attending checked his heart and lung sounds before discussing with us the changes he wanted to implement in the patient’s drug regime. The attending shared with us that the patient’s prognosis was not stable, and that the man himself had, in the worst case scenario, expressed wishes for DNR/DNI (do not resuscitate, do not intubate), yet the order had not been approved by the computer system. We then proceeded to the east wing to continue rounding on the patients there. Less than ten minutes later, the residents’ beepers went off as a code blue was announced.   We rushed to the room and discovered that it was our patient that we had just examined. Prior to beginning resuctitation manuevars, the patient’s chart was checked, and subhanaAllah, the DNR/DNI order had just been approved. As the hospital staff called the family to inform them of the unfortunate news, the attending kept repeating to himself, “I cant believe that just happened..we were just talking to him!”. Although he has seen death many times, this scene was absolutely shocking to him. To think, while we were standing in his room, the Angel of Death was with us, waiting for the man to take his last breath!

The second encounter was with a woman who had undergone numeous surgeries and was transferred to our unit after suffering from aspiration pneumonia. She was extremely depressed, did not want to move from her bed, and constantly asked if she was dying while taking copius amounts of pain narcotics. Day after day she underwent the same routine; her pneumonia resolved but her psychiatric status declined. One afternoon she suddenly decided that she had enough and wanted to die. She refused the oxygen that she was dependent on and with her family present, denied resusctitation or intubation. Her narcotics were administered, and she passed away.

During what we later dubbed “morbidity week”, another patient was admitted with a severe case of pneumonia. Normally, a healthy patient would be able to take a course of strong antibiotics and fight off the infection. However, with an underlying lung disease restricting his breathing, the prognosis was not great. Palliative care, which I previously had never heard of as a branch of medicine, was involved and began to help the family make end of life choices. Surprisingly, the next day, the man was feeling and looking a lot better. He ordered breakfast, talked with the medical team, and watched television. We were pleased and thought that perhaps he might just pull through this time. Two days later, his health declined and he began worsening each day, until his family decided t withdrae everything but the oxygen and pain medications. When I returned to the hospital on Monday, I looked at the patient list and was not surprised not to find his name there.

When you are involved in health care, you have to be prepared to deal with death. One of my classmates declares that she chose podiatric surgery since she won’t have to deal with dying patients, but I beg to differ. Sure, we aren’t the docs who prescribe antidiuretics for a volume overloaded heart failure patient, or attempt to remove an aneurysym without inducing a stroke, but we have our share of risks too. My patient may die while I’m amputating his limb to save him from a raging osteomyelitis infection. Or she may expire under my care when treating her arterial ulcers worsened by her decreased cardiac output. Or they may suffer a DVT when immobilized after a reconstructive surgery despite anticoaguant therapy as a consequnce of Virchow’s triad. At the end of the day, we’re nothing but an hourglass turned upside down, with the descent of each grain of salt towards the bottom marking the approach to the end of our story.