Randomramblings

Death is one of the moments when you stop to think, to look back. When you have to accept that your time is limited. And that it's been ticking out for more than twenty years for yourself and that you want to do so much more with your time, that there are so many things you haven't done yet (even though you vowed you will).

Lately I spent many days thinking about the way death comes unexpectedly and almost always too early. That almost regardless of the life you've had, the pain you've experienced as a result of your illness, one always wants more time when the end is near. Just another day, another week. And there is nothing that can prepare you for death. Even the knowledge that your loved one, a close relative is in the last stage of their illness. And that her life is coming to an end.

I lost the first one of my grandparents in 1992. I remember staying awake that night and feeling lost. I didn't feel anything and knew I should. I knew the adults cried and mourned their loss, but I couldn't. I didn't especially like that grandparent and I was too young to understand the grieving. To understand that death is not like a journey, where you come back; that death is irreversible.

Eight years later my beloved grandmother died of a brain tumor. We knew about her illness, knew she had less than a year's time, knew that death couldn't be avoided and yet it hurt. I remember tears streaming over my cheeks and feeling I couldn't stop crying - whenever I wiped my eyes dry, the tears welled up again. I still cannot shake the feeling that she is alive and many times when I see a similar-looking woman on the street my first thought is always: it might be her. What shocked me about her cancer, about her way of dying is how painful it is. Until then I had always thought of dying as getting to sleep in the evening and just not waking up again in the morning. My grandmother had to have pain-killerers administered to her. First Tramal, then morphine. First pills, then IV injections. It hurt so much that despite the medicine she received, she was still in pain. She couldn't see clearly, she sometimes couldn't speak because of the pain. Her death, even though it was very difficult for me to say goodbye to her, was a means of terminating her suffering. And for that I'm grateful.

With my grandfather's death this year it was again different. I'm five years older than last time and even though I've never known my grandfather quite as well as my grandmother, or loved him quite as much, it struck me - it was a heavy blow. His death was very unexpected and I was forced to realize that some things cannot be put off forever. That time comes, body weakens and life cycle has to continue.

Two years ago grandfather's health started to deteriorate. He was a diabetic and had gangrene on his leg. It spread quickly and was giving him lots of pain; when it couldn't be postponed anymore, they removed the part of his leg from knee downwards. For some time he was pain-free and was discharged from the hospital. Then his kidneys failed and he had to have renal dialysis performed every three days. He had a mild heart attack about the same time. Later we discovered that gangrene started to spread on his other leg. At hospital he almost died from sepsis, but as they surgically removed his heel, the source of MRSA infection, he survived. Then he progressively got better. He returned home and spent his summer there. In September he was slightly feverish, so he was admitted to the hospital again. The night before he died he had his second heart attack, and a few days before that gangrene started to spread on his fingers as well. Had he lived, he would have to undergo a surgery, in which his right hand would be removed. Perhaps he would also need a heart bypass.

Thinking back I know time was right for him. Living to see himself crippled, a patient, spending his days at hospital, being unable to drive his car, which he loved so... is not a life he deserved.

When bodies start to malfunction, when they become unable to carry on with the metabolic processes needed to sustain life, when the systems start to collapse - it's time to go. As a student of medicine, I am left with the realization that human body is mortal and that any faults it might have can very severely shorten one's life. As a future doctor I also know that sustaining life for life's sake only is pointless. Machines can support life processes in a dead person, but is that what we call life? Not that I wouldn't do everything in my power to let somebody live, but there always comes a time when one needs to go. And it's always too early. I am a firm believer in palliative care and think that it is one of the most noble ways to help your patient as a doctor.

It's a circle of life and nothing was more certain for us at the time when we were born than that we shall die some day. And I don't think that's a reason for sadness - it's a reason to do things I want to have done, because tomorrow might be too late, but today the day is still as young and as fresh as to allow for action to be taken.