recently we admitted a patient with 80% surface area burn wounds. in most centers in the world this is equal to a death sentence. in africa there is no chance at all of survival. we knew she would die. it was just a matter of when. she also had mild inhalation burns. usually in the case of inhalation burns the patient would be intubated(tube stuck in trachea ie windpipe to keep airway open and allow breathing) but because she had no chance we ellected not to do this, secretly hoping she would asphixiate in the night. (this is a better way to die than the prolonged agony of the burns and the sepsis that would soon set in) her inhalation burns were however not so bad and she did not die in the night. every day when we saw her on rounds i would ask her how she was and she would give the generic reply that she was fine. this was not true of course. she was in pain and on the brink of death.
we discussed her with the students. the medical facts were simple. she would die and there was nothing to be done. the human tragedy was somewhat more complex. i found myself wishing that she had already lost her humanity because it would then be easier for me to deal with her imminent death. she did not. she remained human to the end, every day telling me that she was 'fine'. every day i found myself wanting not to go into her room. this was selfish of course, because it had to do with me dealing with her death and not with being there for her in this time of her need. i was confronted with the fact that our patients are human and therefore equal to us in every way. i was therefore confronted by my own mortality. most of my colleagues would just cut off from the situation. this i fully understand because there are too many opportunities where one is confronted by this, so as a defence mechanism one cuts off. but if we are really doing this job to make a difference in the lives of fellow human beings, we need to guard against becoming callous. true as surgeons our first priority is to treat the physical person. but why do we do this? it should be to allow the person to get back to the more important aspects of life that define us as human. things like reading poetry and falling in love and the like.
anyway, as expected she died, but only after confronting me with my own mortality every day for a week. some people may think you should never be glad at the death of another human being, but i disagree. i was happy when she died. don't get me wrong, i was not happy that she had to go through the whole ordeal. i was not happy that she got burned in the first place, but once she was burned, i wanted her suffering to end. i was happy for her that she died. but if truth be told i was also relieved for myself that i didn't have this constant reminder of how fragile my own life is and how we rely so much on this shell we call a body to transport us through life.