A frail elderly gentleman was wheeled in on a stretcher and left alone. His paper-thin skin lay gently across his delicate frame like fine linens. His mouth lay agape. His slightly yellowed sclera framed the piercing gray eyes cast upward at the harsh fluorescent lighting. He didn’t blink. He didn’t cry for help. He awaited the inevitable on a stretcher in a hallway of a fully occupied emergency department. I was confused and scared at the apparent lack of treatment he was receiving. There was no crash cart prepared for him. He wasn’t attached to telemetry. He didn’t have a nasal cannula. He lay in bed alone — in waiting. As I followed the resident from bed to bed, I found myself checking on the patient at every possible opportunity. I felt his pulse and held his hand in the moments before chasing my attending down the hall to see other patients. His clothes were jammed into a clear plastic bag at his exposed feet. I covered him with a warm blanket. I tried to make it better. Unaware of my presence, he took steps further away from his existence in this world. With every visit, I fell deeper into my thoughts, getting lost in my mind.
I watched a man die.
As I drove home in the darkness, infrequently interrupted by piercing headlights, I tried to process my experience. I had witnessed death for the first time. I knew not this man’s story. I had neither glimpsed the pages of his introductory chapters nor been captivated by his adventures. I didn’t bear witness to his achievements or know the story of his love, but I was there for his conclusion. I was there to witness the epilogue of his memoir. It was anonymous. It was cold. It was solitary. I couldn’t turn off these thoughts. His absent gaze rattled me. He was innocent in this moment. His demise was no fault of his own. He did not ask for death. When it came time for his exit from this world, he was alone. He had no loved ones by his side to ease his transition. His only visitor was a fledgling medical student, a novice attempting to show him some compassion in his final moments. A gentle fog left beads of water on my windshield. They slid upward, acquiring girth as they merged, and eventually blowing away in the wind. My thoughts turned selfish. Did I fail? What could I have done? How am I supposed to feel? Who can I turn to? Who could possibly understand? I am training to provide care for others, but who will care for me? Does this get better? Am I just naïve? I felt alone. I felt scared. I had met death and it changed me.
I laid in bed. I yearned for sleep, but it would not come. I could not quiet my mind. Eventually, I achieved temporary torpor, which was interrupted by dreams of his gaze. The billowy gray of his iris softened the blackness of his pupil. The beautiful brushstrokes of his grays and faint blues ended abruptly at this stark, bleak darkness. There I was again alone. I wanted to return to the this portrait of his life, but I was drowning in the solitude of the end. I was lost in his death. Again, finding myself awake, the rain pounded an incessant ballet. I found myself jealous of the drops. They danced joyously to nature’s unending poem, lit by the light of the moon and the stars, and cared not of the suffering I had witnessed. Their existence was one of temporary bliss. Born of the clouds, they fell ecstatically with a view of all existence. The mountains, trees, oceans and fields of this world existed for a brief instant to them. I had missed this exposition in the narrative of the dying man. I had missed the joy of his beginnings and the development of his story amidst the fruits of life he had sown. I could bear witness only to the end of his journey. Only the end. But his participation in the eternal choreography of life continued to resonate in my thoughts.
I continued to listen to the rain. I took a moment for myself. I recalled the lessons of Dass and de Mello. I allowed myself to wander — to let go. I felt my breath move within me. I could hear my heartbeat. I became aware of all of the sounds and smells that surrounded me. I achieved a new state of awareness. My thoughts became fleeting. I was an observer of myself — no longer an active participant. It was in this moment of clarity that I heard the soft whisper of truth emanate from my deepest consciousness.
I was involved in this man’s death so that he could teach me the dignity and care that is deserved by all. I did my best to ease his suffering and to treat him with reverence and respect. I did all that I knew to make him feel like he mattered, show him love and assure him that someone cared. This was no accident. Though I struggled for hours to rationalize my experience, push it away and change my thoughts, I needed it. I needed this moment to grow. The enormity of this lesson is not one that I will ever forget. In this moment, this delicate figure became my guru, my teacher and my guardian in my inaugural encounter with death. It was not my consoling him and providing him comfort, but his granting me the privilege and protection to learn to cope with death in the safety of his presence. I found peace in this meditation. It allowed lessons of empathy to echo in my mind. It is compassion that tethers the quilt of humanity and links us across cultures, creeds and continents. This compulsion is inescapable, and binds us to complete strangers in their times of need. My intrinsic solutions to emotional tumult framed my situation in an entirely new light. Though I felt suffering and experienced grief, this day was not about me. It was about my gentle shepherd. This man deserved not my pity but my gratitude. His intervention in my life was not meant to cause pain, but to guide me into a more sophisticated perspective both as a physician and as a man. He guided me to an entirely new domain of thoughts and elevated my practice. He was my mentor in the final leg of his journey. He had shown me more than just the pages of his own magnum opus, for he had presented me with a new compass with which to navigate the literature of life with respect, honor and love.