An adorable little kid was born to a young mother in her early twenties. With an absolutely uneventful pregnancy and giving birth to a beautiful healthy child, the mother could not have even guessed, what lied ahead of her. At about 6 months of age this little girl fell sick. At first what looked like a common flu later developed into a fever which just would not come down. When the fever was accompanied with nose bleeds, the mother knew this was something ominous. On further investigations this little kid was diagnosed to have infantile leukaemia and her mother's worst fears turned true. The diagnosis led to beginning of this childs treatment with chemotherapy. Infantile leukemias respond less well compared with other childhood cancers. This fact was completely understood by the parents of this child before commencing treatment. And so started the effort for cure, from the treating team and parents alike.
With the start of her chemotherapy was the start of her hair loss. Inspite of that she was everyone's favourite. The staff nurses adored her, the doctor on duty doted on her and so did her fellow patients and their families. Slowly the kid started to get better and look healthier. Like most childhood cancers, this child also went through intense phases of treatment, with being in and out of the hospital on most days. But the parents faced it all gracefully.
Unfortunately, a year into her treatment she started showing signs of relapse. The parents were very disheartened and in no time, the disease flared up and the treating team could offer only best supportive care with no hope for cure. The morale of the entire treating team had also dwindled. Slowly her health started getting worse. Parents and the child now spent more and more time at home rather than make frequent visits to the hospital. A month of suffering passed. Slowly the end seemed very near. And on a fated Hindu New year day she stopped breathing while at home. She was rushed to the emergency department and as decided no attempts at resuscitation or heroics were tried. (Apparently prior to her demise, there was an entire 36 hours when that angel couldn't sleep or feed. She just lie awake with eyes open and groaning, narrated the parents later.)
The doctor who had seen her from day one of her illness was there to receive the baby now only in the form of bones n flesh. The doctor certified her death, but couldn't hold back her tears and she cried all through the formalities . Not just the doctor, but the security guard on duty, the nurse, the technicians in the hospital all were teary eyed. It was one of the very few times that the whole hospital witnessed heart ache at the demise of one child.
But the sad truth or fact was that with the next day's sunrise, the hospital stood where it was. The work did not stop. The banter in the emergency, the doctors scurrying around, the staff nurses tending to the patients all remained in place. It was just like any other regular day. And the hospital was ready as ever to accept and treat new patients, just as they did before. The tears in everyone's eyes had dried up. The remorse and sadness on their faces were replaced with smiles for their other little patients. What remained however, was a lingering feeling, her memory and her ever-smiling face burned in the back of all of their minds.
How many of our non-doctor family and friends have asked us(as doctors)- 'How are you so accustomed to seeing patients, especially kids, die?' 'Don't you feel anything?' How many times have we, doctors, declared a death and found ourselves moving on to receiving the next patient with a 'teary eyed smile'? How many times have we felt helpless while we await the inevitable? Does that really make us heartless and indifferent? Have we really become so oblivious to death that it does not bother us anymore? And is moving on defined by a time limit? Does moving on make us apathetic? Every doctor at some point of their career has asked himself or herself these questions... Only to find the minds caught up and confused.
There has been a constant war between the 'doctor' in us and the 'human' in us. The 'doctor' in us justifies saying that he swore to treat all, leaving behind our emotions. That his time and attention is well deserved by someone whose life can be saved rather than on the thoughts of someone who is no longer living. The 'human' in us justifies that if as humans, the loss of another human being does not bring tears to our eyes, then we are perhaps not human any more... And so the argument continues.
The truth, in fact, is that no one taught us in med school how to handle the loss of a patient you get emotionally attached to. How to play with life and death on a daily basis! Fortunately, it's a survival instinct, that must have developed probably after the first time we cried, on the loss of a patient. Or probably, much before that, when we realized that death is an indispensable part of our life's, as doctor's. An instinct that helps us remain sane. An instinct, that must be present in every human, only to be amplified and deeply embedded in us, as doctors. And that is both a sad and happy truth. The doctor in us does not have the luxury to grieve. But the human in us has the luxury to treasure and cherish memories. And both have the right and duty to move on.
What we as doctors and humans have to realize that our biggest responsibility and achievement is to 'move on'. To embrace life and it's very many uncertainities.
To fall, to get up, dust off and yet keep going...