What happens when the physician becomes the patient and when death comes calling? Reflections of a surgical oncologist
Dr Ajit Pai
The year is 1812. A tale is told of a physician who is guided by death in his ministrations. The doctor becomes famous for his ability to sense who could be healed and for whom there is no hope. Eventually, his endeavour to cheat the grim reaper, to help a sick woman ends with the candle of his life snuffed out by death. This tale finds resonance in today’s grim times. Physicians are succumbing to the COVID-19 virus in droves. Fathers and mothers, sons and daughters are disappearing from this earth as they go about providing succour and hope. The threat of passage, imminent, real and present, which threatens the covenant between the patient, the doctor and the maker has never been more evident.
As we individually and as a collective strive to reclaim life for the dying, we find death shadows us, claiming one as his next victim; perhaps agnostic to the individual who has to depart. The initial days of the pandemic were dark and filled with fear and uncertainty, as frontline workers like me were exposed to a poorly understood foe. We trudged on nevertheless claiming life for our patients, risking our all. Several colleagues were infected with COVID-19 during those nascent days. An anaesthetist by profession, he likely contracted the disease while in the line of duty. Hospitalised for several days, he describes his time in the hospital as filled with guilt, despair and waiting for the inevitable. Guilt for infecting his family members and then being isolated from them, despair knowing there were no effective treatments at that point in time and waiting for the inevitability of possible deterioration and death. He survived and is a much more empathetic physician now he says, having trodden the same path as our patients and his blood is bound to that of the patients he and we as a collective treat.
Death would appear makes us all equal. The fate of the human race perhaps stands on the knife-edge of our response to the perceived risk of mortality and the cloak of immortality thereof.
As a surgeon treating gastrointestinal cancers, I am surrounded by death and yet I’m defiant. I struggle every day, all day, using every ounce of knowledge, skill, training, intuition; all in pursuit of the holy grail that is fundamental to oncology- to cheat death against all odds and let life breathe a little easier and a lot longer. Though we yearn to look like in the eye and turn back from youth, to face death with a smile and open arms as a measure of our legacy for ages to come, I suspect here in the deep, steady hands waver and hold us back. In peacetime, it is said, every man or woman is a hero; but it is in war, a great test of our times that we find what we are made of.
How then does one prepare for the spectre of death, that shadows our every step in these dark days? Will the grim reaper find us cowering in our beds and our safe houses or will it find us like Horatius at the bridge, mouthing “To every man upon this earth, death cometh soon or late, and how can man die better, than facing fearful odds, for the ashes of his fathers, and the temples of his Gods?”
I for one have left words for my loved ones to read and rejoice, a soft bower of roses to cushion my fall; a song which should echo far into the distant days, yet to come. It is reflective of the altered reality which marks our days.
Perhaps this is our song as a mass of men and women, a paean to the knights we espouse to be.
When I Die
When I do the inevitable and fall into the dust,
Let me go without the sirens and the codes,
The machines and the potions,
Let there be no sad songs nor wailing,
No mourning and no crying,
No flowers and no incense,
No cortège and no procession,
No grim faces and no pallor of gloom.
Let the drums beat and the music roll,
Jazz and country and rock and roll,
Let the drink flow and the cellar run dry,
Till there’s not a sober fool,
Nor a hungry heart in the house,
Let the earth ring with the noise
And eyes stain with the colours of a life lived in profusion,
And let the words be from the heart,
Raw and real and unscripted,
Slake not the wounds of the living with the words of the dead,
Burnished and wise though they be
Let the mighty oak live on
In memory rich and green, pulsating with life,
The dark corridors of the dead haunt me no more,
Four score years among the living haunt me more,
And I must reach that place beyond the sea of sorrows
Before I am frozen into this life,
And take me down from your walls and your museums,
Your temples and your shrines,
That is for the faded, not for me to you and you to me,
I am the first ray of light
And the blazing hues of the setting sun,
The first showers of spring and deep snows of the ending year,
And I cannot be captured nor kept alive
Anywhere but in you, as you laugh and rejoice,
Singing my words and dancing to my tunes,
In the green valleys of our youth