A Prayer for the Dead, A Prayer for the Living

As a first year resident physician, I am just beginning to understand the responsibilities and the practice of medicine. I have difficulty telling people “I’m a doctor,” because I’m not sure I believe it myself. And yet within the past eight months, I have already been challenged to mediate situations that bring me to not only fully accept my vocation as a physician, but also to grow on a mental level, a human level, and a spiritual level. In the following reflection, I recount one of those moments that occurred during a rotation in the medical intensive care unit.

At 6 p.m. I was coming on for my night shift knowing that the family of one of the patients I would be caring for had decided earlier in the day to withdraw medical care for their dying sister. The woman had been admitted to the ICU the previous night unconscious and in multi organ system failure—heart, lungs, liver, kidneys, all failed—as a result of chronic alcoholism and most recently drinking daily for three weeks with barely any other dietary intake. She was being kept alive with mechanical ventilation and three IV drips of medications to maintain her blood pressure. She was 45 years old. After a few more hours of saying goodbye, her sister came up to me and said that the family was ready to proceed. To withdraw care. I thought a lot about this phrase we use “withdrawing care” that night. This encounter was the first time I had ever been the physician entering these orders into the computer. To me, what I was doing that night was in fact the complete opposite of “withdrawing” care. I felt, instead, that I was giving even more care. How?

First, by caring more for the patient. By making sure she was comfortably extubated, by helping to reposition her in the hospital bed in a way that appeared more natural, and by praying. I prayed that when we stopped the pressors and the ventilator, she would pass quietly and find peace in Heaven, when she perhaps found very little on Earth.

Second, by caring more for her family. It was my responsibility to guide them through this dying process, a process that I had only encountered two or three times previously in my life. I felt unsure, frightened, and nervous, not wanting to make a mistake or be inadvertently insensitive. Once again, prayer and what I perceive to be God’s grace filled me with the love I needed to outline the process, to encourage family members to hold her hand and to speak with her while she died.

Once the medications were stopped and she was breathing unassisted, her lungs gasped once … twice. Was the soul being released from the body or was the body clinging onto the soul? And then, within two minutes, silence. I left some space to pause and then when the time felt right, stepped forward for the death pronouncement. “The heart is not beating, the lungs have stopped breathing” was all I could manage to say. Why did I remove the “she” and “her”? Why could I not say, “She is dead”? At the time I could not have answered those questions. Thinking back, I believe it was easier for me to vocalize that her body had simply stopped functioning, while I quietly held on to the belief that her soul continued to exist. Should I have held back as I did? Would it have been better for the family to hear that their sister was unquestionably dead? Perhaps. Nevertheless, the family understood, they cried, they held their sister’s hand. And then let go.

At this point I took a breath, left the room, and without pause stepped straight into …

A 46 year old woman with a history of drug and alcohol abuse was being wheeled into the ICU on a hospital bed right in front of me as the door behind me closed. Her nose and mouth were caked with white powder and she was in the embrace of some hallucination, clawing...