A sharing by Tan Yew Seng
The drawing was a fascinating portrayal of a medical student’s experience with a patient’s death in a hospital intensive care unit. The medical student was barely stepping into the room — his backpack was still on both shoulders — when he was confronted with the scene of death. He stood statue-like, eyes widened and mouth agape, either in shock or in terror. Unless he had a crew-cut hairdo, we can see that his hair was literally standing on end. His stance, with the arms hanging limp and purposely on the sides, was graphic of his utter helplessness and unresponsiveness.
To his left, the deceased’s two children were squatting, and looking forlornly at their crying mother and dead father. The widow stood with hands on her face, eyes closed, presumably crying, though strangely, tears were not drawn. It was interesting to note that all the characters were illustrated without proper hands, just stumps — perhaps underscoring the sense of ill-function and purposelessness.
The patient’s eyes were closed, and his hair was disheveled. Attached to his body were electrode leads that were connected to an ECG machine that indicated asystole (the “flat line” reading). It was probably ironic that the attachment to the ECG machine was the only form of “connection” depicted in the drawing. The human figures were not depicted as touching each other — the student, children, wife and patient were spatially discrete and separate from one another. It was also significant that the medical student was the closest to any healthcare provider that was depicted in the room in this scene of grief, sorrow and neediness.
And at the top were capitalised lyrics of a song that arose for the medical student. They appeared to come from the song Seasons in the Sun by Terry Jacks, except that the lyrics were misquoted —- instead of “it is hard to die”, the version in the picture was “it’s time to die”. Unconscious or not, this appeared to be an epiphany about both the inevitability and loathing of death. The perceived incongruity of death in the midst of life “when all the birds are singing in the sky” summarized his reaction to the experience.
Commentary
Reflecting on this picture evokes some thoughts about the way we approach death and dying in healthcare:
- How do we train aspiring (and even practicing) doctors for their encounters with death of their patients? Studies have shown that the death of patients can leave impactful memories in doctors, which may in turn affect the quality of care. It is also known that there is little support to help medical students and doctors process their experiences of patient death.
- This picture probably arose from a more sensitive appreciation of the broader experience of death. It is so easy to intellectualise dying and death as a medical or pathological phenomenon and pretend that nothing else needs to be dealt with when the patient is dying or dead. This student was depicting what death means as a human and social experience, not just a medicalised one.
- The student was also a witness to the lack of care and support at the end of life, ironically when they are most needed. Perhaps this has to do with the overemphasis on medical treatments and interventions to rationalize our professional purpose, that when the situation is deemed “medically futile”, care is rationally withdrawn and care providers leave (or avoid?) the scene.
- It also does not require much imagination to perceive the negative spiral that can come out of this situation: the more we avoid addressing the care of dying and death, the more we will create such scenes of desolation and the more healthcare providers will experience terror and helplessness, which will in turn lead to more avoidant behavior
Dr Tan Yew Seng is a family and palliative medicine doctor now working at a private oncology centre.
The commentary and the vignette were reproduced with permission from the book “ Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
