A glimpse of heavenPosted: 24 February 2015
We thought he wouldn’t make it to the afternoon when we visited him in the morning. We, a cloud of white coats, gathered around his bed. The attending took his hand and looked him in the eye for a long time. He sighed. There is no way to translate his words into concise English, but he said the equivalent of ‘You’re very ill. We are afraid that you will not live for much longer.’. They shared a moment together, he, the oncologist who helped and guided him the past few years, him, the man whose body was now really failing him. He didn’t say anything but it was clear that he understood.
I had the responsibilty of caring for him during his last hours. Before this internship, I would have never felt up to this, but somehow, pieces just fell into place and I could finally become that doctor I wanted to be, the rock in the storm.
However, he didn’t die that day. And not the day after either. Family members from all over the country visited, said their goodbyes. He was surprisingly lucid, at the beginning we thought that maybe there were some signs of delirium but these receded. I began to feel some hope again, despite the odds. But on one morning, I read in the file that the patient was now barely able to wake up.
Being a ‘sub intern’, my patient load was lighter than that of the residents and I was able to check in on my patient every couple of hours. We never spoke of much, I watched him silently for a while to see if there were any signs of distress and then tried to wake him to ask him if we could do anything to make him more comfortable. This little rather one-sided conversation would last a few minutes and then he would fall asleep again and I could turn my attention to the family members.
There is always a kind of holy atmosphere in the room of a dying person, a silent anticipation of what is going to happen. I can’t describe it in words but it’s a very powerful atmosphere which makes me pause every time. It’s the atmosphere that is created when someones soul is preparing to depart their body. Do I belive in the ‘eternal soul’? From a theological and scientific viewpoint, I don’t. I can’t. But with this specific patient I experienced something that transcends simple answers.
He had now been dying for almost twelve hours. The family was getting restless, asking me how much time there was left, couldn’t we do something to speed it up (the patient was now entering the phase where the brain sort of disconnects from the body and sometimes forgets to breathe). I answered their questions to the best of my ability – we never know ‘how long it takes’,
Dying is a really strange process. Sometimes, it happens in an instant, but sometimes, it’s a long and drawn out journey – sometimes, it feels almost equal with a birth but then in reverse. ‘Letting go’ takes a lot of energy, it’s certainly not just a passive shutting down of bodily function. So I’m honest with family members and explain to them that ‘the last part of life’ doesn’t just ‘happen’, it is an active process, and as a family, it often helps to talk to the person, to touch them, because hearing is the last thing that stops. And of course, this takes a toll on the family, and it is important to urge them take care of themselves, take breaks, go home to sleep for a while – but we can never ‘predict’ the moment of death. ‘Euthanasia’ is completely out of the question as that has to be requested by the patient themselves. In case of refractory symptoms, we can administer painkillers or other symptom-directed therapy, and in rare cases of terminal anxiety, we can administer a sedative. But usually, when a family asks me to ‘speed things up’, the patient is already oblivious to what is going to, far away on their journey to the next life, and is is their discomfort that prompts the question.
As usual, I also tried to ‘contact’ the patient. I remember vividly how I was almost afraid to speak to dying patients when I started working on this ward, as if I’d disturb them, but I learned by example of a great oncologist that patients usually really appreciate the care you show them (or they will just continue to sleep). I softly touched his hand and said his name. I did not expect a reaction but I wanted to try anyway.
He opened his eyes. Hi, he said. Hi! I responded enthusiastically, maybe a little inappapropriate for this situation, but I was so surprised that he actually spoke that I said the first thing that came to mind. He returned my gaze and we shared a moment of silence.
It felt like hours. I don’t know what happened, but I was suddenly connected with my patient on a level that I have never experienced before. We saw each other, he saw me and I saw him, and it felt like we belonged, like it was exactly right. There were no barriers, there was no doctor or patient, we just were.
I was suddenly jolted back to the present and I had to struggle to control my emotions. My patient had gone to sleep again, the crackling sounds of his breath filling the room. I didn’t say much but I think everyone present could see how touched I was.
What happened? I don’t know, I think I got a glimpse of heaven. I’ve read a lot about near death experiences and how they can also be felt by observers – this felt like it. The odd thing is that I can hardly put it into words. It was just a moment but it was so much more than that. It was like coming home, arriving after a long journey and seeing that this is your place. Nothing changed during the mere seconds that this lasted, but I felt like I had been somewhere else, in a very bright and light place.
I will always cherish this experience, this gift from my patient. I think it’s the best gift ever. It’s a glimmer of hope in the very dark and bleak reality of the oncology ward.