On Death and Crying

Author’s Note:  No patient names or identifying characteristics were included in this story.

Mavis was unconscious the first time I met her. She was elderly, approaching 80 years old, and lying in a hospital bed with her eyes closed. A crop of silvery hair washed haphazardly across her forehead. The bony outlines of her shoulders and hips showed through her flimsy hospital gown. Her limbs were slightly askew as if she’d fallen asleep suddenly before she’d had time to settle into bed. Mavis wasn’t asleep, though—she was seizing. Her brain was trapped in a prolonged seizure, but without any of the convulsions that I had come to associate with seizures. She lay peacefully, her chest rising and falling slowly. A series of electrodes were attached to her scalp, recording the electrical activity of her brain and transmitting it through several wires to a device that synthesized the signals into a pattern. I couldn’t read the pattern for myself, but the neurologists in the room taught me that it showed a seizure. I later learned the term for this peaceful kind of seizure: non-convulsive status epilepticus.

I was a third-year medical student at the time. I had spent two years learning medicine from textbooks; my third year was the year that I began learning how to care for real patients. Mavis was one of the very first patients I’d been assigned to care for. At the time, I imagined the hospital as a sort of theater. A series of actors would emerge to play their given roles: patient, doctor, student, nurse. There would be drama, and perhaps suspense, but ultimately there would be resolution. As with most dramas, the resolution would usually be satisfying. I had a vague understanding that some patients wouldn’t get well, but I only knew this in an abstract sense. Without realizing it, I implicitly assumed that bad things would happen to some patients—just not to my patients.

As the medical student, I worked with a team of doctors that was taking care of Mavis. The team consisted of neurologists-in-training, called “residents”, the supervising physician, called the “attending”, and me. The residents made a plan to administer anti-seizure medications and keep close track of the electrical activity coming from Mavis’ brain, which would show if and when the seizure had resolved. The attending agreed with this plan, the residents ordered the medications, and we all left the room to see our next patients.

I went to check on Mavis when I got to the hospital early the next morning. She was awake! She was sitting upright in bed, knees pulled to her chest with a blanket over her legs as if she were getting cozy at a slumber party. I was surprised, given how dire she’d looked the day before, but pleasantly so. I introduced myself as a medical student helping take care of her and we exchanged pleasantries. She spoke freely and casually in the conversation that ensued, telling me about her childhood in rural England and her life as an immigrant to the United States. I discovered that she was fluent in English, French, and Polish. As our conversation concluded, she told me she thought I was a nice boy. I was delighted. I still didn’t know much about her medical condition, but I knew that she seemed better. I was content to know that we had done our job successfully.

Later that day, the medical team convened to discuss the patients we were taking care of. I perked up when Mavis came up for discussion. I waited to hear the doctors congratulate each other on a happy ending, but it never happened. Instead, after reviewing her medical history and discussing the results of her blood tests and her brain recordings, they concluded that Mavis was going to die. Beneath her wry smile and her gentle laugh, Mavis’ organs were shutting down. There was a term for that too: multisystem organ failure. Her liver and kidneys could no longer function as intended. The waste products that they would normally have metabolized were building up in her blood instead. A buildup of these waste products had caused the seizure that brought her to the hospital. Though the medication she’d been given had broken her seizure, her underlying organ dysfunction couldn’t be reversed. I was told there was nothing left to be done for her.

Mavis’ grim prognosis came as a shock to me. Given how little I knew about her condition and how much she had seemed to improve overnight, I had assumed that she would continue getting better. Having never experienced death firsthand, I’d always imagined dying people as barely conscious or struggling to breathe, so ill that death’s arrival would be a cosmic mercy. To me, Mavis was fine. Her mind was still sharp. She could still teach me Polish phrases and laugh at my clumsy attempts to pronounce them. Yet we were preparing to discharge her to a hospice, where the only goal would be to keep her comfortable until the end. It all felt terribly unfair.

On the night before Mavis was to be discharged I visited her room one last time before heading home from the hospital. She was sleeping peacefully, and I thought better of waking her. I sat in a chair next to her bed and watched her sleep for a few moments, struggling to accept that she was meeting her end. One phrase dominated my thoughts: this isn’t fair. A few warm tears escaped my eyes and rolled slowly down my cheeks. I was frustrated. Mavis had more life to live, more jokes to tell, more memories to make. The only thing she didn’t have more of was time.

Sitting there by Mavis’ bedside, the assumptions I’d held about the hospital were falling apart. Life happens, but sometimes, despite our best efforts, death happens too. Having thought of the hospital as a place where people go to get well, I hadn’t fully considered how it’d feel to know patients who wouldn’t get well at all. For the first time, I was seeing behind the curtain. Sometimes, people die before their time is up. Learning to deal with those losses would have to be part of the job.