“There is a sacredness in tears. They are not the mark of weakness, but of power. They speak more eloquently than ten thousand tongues. They are the messengers of overwhelming grief, of deep contrition, and of unspeakable love.”
—Washington Irving
While working in the hospital, I transferred patients to the designated COVID floor to be tested. One particular patient was critically ill. I wanted to make sure I had considered all possibilities as to why our patient continued to be ill after initial appropriate management. I searched the literature to understand the varied presentations of the COVID infection.
The literature available is useful, plentiful, and mostly anecdotal with few evidence-based articles. The recent literature highlighted the ethical issues related to the tragedy of this pandemic. Issues related to rationing, who deserves to be treated, who to treat, who makes these decisions, and so on, and even more grave issues surrounding end-of-life and resuscitation scenarios.
The recent Washington Post article with the headline “Doctors consider universal do-not-resuscitate orders for coronavirus patients” had a high circulation index on the social media. This caught my attention and created tremendous discomfort. What would I do, who am I to make this decision, am I playing God?
In non-COVID settings, I take the approach of mutual conversation and discussion with the patients and/or their caregivers or power of attorney for healthcare, ensuring that the patient’s wishes are paramount, honored and respected. When controversies exist I seek assistance from my colleagues, resulting in a process that feels well thought out. The headline seemed to be contrary to respecting the patient’s wishes. The logic in the article would seem okay in hypothetical discussions, but the situation is current, more real, and palpable. At any time, any of us will have to take actions that may articulate the wrenching decision to prioritize the lives of the many over the one.
This thought dominated my mind and entered my conversations that day. We had team discussions in indirect ways about the article and our own thoughts.
Later that evening, my intern Natasha sent me a poem she had written. She had shared earlier that she wrote poetry and I had requested her to share some with me if she would be comfortable.
As I read her poem, Bell Tower, with tears in my eyes, I could picture her soft caring voice loaded with authentic compassion, stroking the brow of her patients, the other hand clasping one of her patient’s as she whispered these words of comfort. That is who she is each day with each patient! I read her poem a couple more times. I wanted to know more, so I asked if she would share and she did (below). Thank you, Natasha, for being you. We are blessed by you.
“An inevitable facet of medicine is becoming comfortable with death. Throughout medical school and the past year as an Internal Medicine intern, I have had my own struggling relationship with this component of caring for patients. Although it has been difficult, I have found ways to help myself understand this process, and more importantly, support others. It is a continuous journey, and I am humbled to learn more every day from each person I encounter. The passage below highlights my personal thoughts throughout this process.”
Bell Tower
From the brim of the sunlight’s warmth to the deep and blue wake of the night,
I listen to you in these moments
The stories you so earnestly share, no hesitation, a window into the timelessness of your life.
One so full of wonder and reminiscent of memories captured by your mind and kind voice.
Time has no escape, making its appearance as quickly as it leaves.
Fleeting, intangible, careless. It is the increment of our lives, un-measurable, despite our efforts to measure it.
Our lives cross in this exact moment in time, as you begin your journey into the next phase You’ve taught me to hold it, live it, make it count, to not fear
What lies on the other end.
The lines of your face, the soul in your eyes. You are a gem, complete, timeless.
The bell tower inside me rocks incessantly back and forth.
It enters the shadows of pain and grief, then drifts, bends, and rocks its way to strength, comfort and sturdiness for you.
These dueling forces interrogate me, yet encapsulate me.The room becomes heavy, the air condenses as you begin to leave us
I wish to care for you and help you rest—Natasha Amjed
Enjoy this picture she took in her parent’s backyard:
#REFLECT: How is your heart prepared to be a trusting (not fearful) witness to someone’s end-of-life journey? To your own?
Love this so true im praying for you blessings God is in control He has blessed u in so many ways yes we are to lean o. GOD at all times he will bring us through if our mines are stayed on him for that perfect peace continue to stand tall like the palm tree planted by the water we may bend keep praising him in the strom.Much Love .Appreciate All you do God never Fails!
It is the paradox of life that it fears the inevitable certainty of death while trusting and relying on innumerable day-to-day uncertainties. Howsoever strong one’s heart may be, when it comes to facing death, their own or others, even lion hearts become weak. This is specially so when the other is a loved one.
On the other hand, there are those who come face-to-face with death as a part of their profession. They may learn to remain detached about death, even when emotions may overwhelm them.
As a physician I have witnessed death on quite a few occasions. I can say that I overcame the fear of death even though I could not remain oblivious to the end-of-life journey of some of my patients. I can also say that I have been a trusting witness of these end-of-life events, without fear, for myself or for the ones on the other side. Death has never evoked fear in my mind or scared my heart.
Personal and professional occasions apart, it is human to make the end-of-life journey of any one as peaceful as possible, physically by relieving the pain and suffering, mentally by supporting and soothing with empathy and kindness, and spiritually by offering prayers and invoking blessings.
It is humane to see that no one dies alone. Mere physical presence, a smile of understanding, a gesture of solidarity and support by simply holding hands, making eye to eye contact to reach and touch the hearts, words of compassion and consolation, and attempts to fulfill their last wishes can make the end-of-life journey trusting and contended, especially for those who fear death and are scared of it. It should be a privilege to be a partner in this endeavor of the departing one to feel ever wanted rather than to end one’s life as an abandoned soul.
On the other hand, blessed are those for whom the end comes without fear, but with peace and understanding. It is humbling to see them transit from this world to the other with ultimate surrender to the Supreme Power
As for being a trusting witness to my own end of life journey, I pray that it may be a long way ahead. As for my preparedness for it, I have reached the age and stage of my life where death seems irrelevant. I am an extremely emotional person at heart and with a very sentimental mind, where tears flow automatically and uncontrollably when simplest things touch my heart. On the other hand, I am neither irreversibly attached with nor totally detached from, my near and dear ones. It is just that I am prepared and ready for end of life journey to my destined destination.
I wrote the following poem on my 80th birthday in 2016, which perhaps sums up my preparedness for my end of my life journey.
Pilgrim
I am a pilgrim, on an eternal journey, mostly through the dark.
On my way, I will meet many stations, many shining stars.
It is not they, but my Destiny will guide me, to another star,
to continue my journey through its brilliance
for another period, another ‘Life-Time’.
At the end of this pre-determined period,
I will leave that star too
And continue my journey, again in the dark,
In search of another station, another star, another ‘Life-Time’.
I am, but just my soul, a part of my Eternal Father,
Always a pilgrim, always travelling,
Sometimes, in dark, sometimes in the light called Life,
In search of my Eternal Father,
To re-unite with Him, and end my journey,
Forever and ever.
Acceptance, diversity, harmony and tolerance,
tensions of relationships, stresses of hardships,
are part of this stopover station, called Life.
My soul is the only Light that guides me,
through the ‘Brilliant Darkness’ of this station called Life
At the ‘Sunset’ of my Life, I prepare myself, once again,
to travel in the dark, guided by the Light of my Soul,
looking at the stars, not for their guidance but to know,
in which star lies my Destiny, my next bright station, my new Life.
My Soul is my Light, My Destiny is my Guide,
My Eternal Father is my Destination.
My Life is nothing but a station of this eternal journey,
through many lives, many stars, many stations till I,
reach and reunite with my Father,
forever and ever and ever,
never to return to mortal life.
Amen!