Mr. B’s Death
When I was an intern, the first or second patient I was assigned to take care of was Mr. B, an 80 something year old man who had suffered a stroke a day or two prior to July 1, 1976. July 1 is a fate-filled day in hospitals in the US because a new, anxious bunch of medical students are now officially doctors, released almost entirely into hospitals where they learn the real nuts and bolts of how to take care of people’s medical needs. They are under the supervision of doctors a few years older than they are and who are their guides and teachers.
Mr. B possessed a remarkable presence and it imposed itself on me from the first moment I saw him. He was in bed in his single room, gazing out the window when I entered and he turned his gaze towards me and looked at me with sharp blue eyes which seemed somehow to look from some enormous distance, both present and absent at once. He could no longer speak, his face drooped a bit on one side. His body was like a tree stump rooted from some primeval place and tucked incongruously beneath hospital sheets. He was short and very powerful looking despite his age and infirmity. His hands especially commanded my attention: they were thick, heavy working hands that had the appearance of a gnarled oak bole. He could easily have been a character arisen from a fairy tale where trolls and goblins contested. Mr. B was obviously a man who had fully lived in the physical world and who now suffered from the ebbing of his physical self. When he attempted to speak in response to a question or two I posed, his English was mangled and incoherent with a strong Italian sounding accent. Somehow, the tableau arranged itself in my mind during the few minutes of my first visit with him into a scene of great dignity. Mr. B seemed capable of wrestling intensely with life’s challenges, but equally capable of accepting what had not the force to challenge. How balanced and rare that quality seemed to me.
Before many days passed, during which little of medical value was accomplished, I had met many of Mr. B’s family, so many people it seemed to me I was meeting an entire village. Every one of them seemed to love this suffering man who I learned had been a skilled gardener and landscaper his entire life. Within days, they somehow seemed to have adopted me into family as well and began to bring me food sufficient to feed my own village. Their warmth and hospitality troubled me a little because it bundled up their hopes and handed them off to me, as though I might bring back Mr. B’s usual robustness, something I knew was far beyond my own skills and the skills of any known medicine. Some of Mr. B’s brain had died and while other parts of his brain might try to make up for the parts missing, they would largely unable to make very much difference. Of course, the family members generally knew this as well as I did, yet there remained a buried, unreasoning hope which poured from their eyes into my own. They wanted something I wanted too but would never deliver and I felt undeserving of their food and affection.
Mr. B’s condition settled down onto a plateau where he was deemed ready for transfer to a rehabilitation hospital where efforts would be made to help him manage his new disabilities. I was on call and therefore in the hospital overnight on the night prior to his discharge. About nine o’clock, the head nurse on our ward summoned me to see him.
The hospital rooms were like small sterile hotel rooms. A door, usually open, led into the room past the bathroom on either the right or left side. The floor was some hard and easily cleaned material that felt like stone. The walls were plaster painted an unappealing greenish color. The room itself was small and nearly square with the bed tucked behind the inner wall of the bathroom and thus partially hidden from the traffic in the hallway. Various orifices were in a panel above the head of the bed allowing for oxygen, vacuum, or other useful equipment could easily be accessed. A television hung from the ceiling. Easily the nicest feature in the otherwise sterile room was the large window that provided a view of some trees and a golf course across the street some two hundred yards in the distance.
As I came hurrying into the room after the nurse’s page, I saw myself for a second reflected in the window that now, with darkness outside, had become a mirror more than a window. That glimpse induced in me that familiar but odd sense of both being within my own experience, but also outside it, as though I have become an observer to my own actions. My heart was pounding, not from the exertion of running to the room, but from apprehension about what was awaiting me. The nurse stood at the head of the bed on the far side.
“I think you’ll have to pronounce him Dr. Browning,” she said to me.
There is a curious relationship during the first weeks of July between nurses and the new interns. The nurses addressed us as “doctor,” although they were frequently older and far more experienced. Good nurses learn a great deal of medicine and often know a good deal more than interns do about the proper care of the hospitalized patients, but they do not make decisions and they defer to doctors. Interns know these disparities exist and handle them in various ways. Some are arrogant, and distain discussion with nurses. Some are glad for the nurse’s aid. Some nurses had a lovely gift for giving assistance without seeming to, and some seem nearly angry, barking objections.
Maureen was a generous woman in her forties with lots of experience who may have known Mr. B would be the first patient I would formally pronounced dead. The event is more complex than one might suppose. Is this actually the end of life? Or should more efforts be made to sustain or retrieve life? I could call a code that would summon a half dozen people to try to restart Mr. B’s heart. Was he somehow not dead until I said he was? A sort of ridiculous notion, yet the doctor’s official pronouncement feels as though it carries that burden, and thus the wish to postpone what nature has imposed. Moreover, I had heard stories of doctors who had pronounced death only to learn their patient was still alive. I knew that maybe ten members of Mr. B’s family still clustered in the hallway and that I would walk directly into them leaving his room and that they would surround me like gulls around food when I opened the door. Maureen knew just what had happened: Mr. B had suffered another large stroke, depriving his brain of oxygen and sugar and starving it to death and this time, ending his life. Perhaps she also knew what I dimly felt: Mr. B could not tolerate a life where he was so horribly reduced. Trying to keep him alive was almost certainly pointless medically, and cruel even should he somehow be revived. I felt for a pulse in his already cool wrist, then in his neck, and then listened to his chest with my stethoscope. I saw he had no respirations and his eyes were fixed and his pupils dilated. I pinched his trapezius muscle hard, but there was no response. Death is utterly silent.
I looked at Maureen and, feeling foolish for telling her what I knew she already knew, said, “He’s gone.”
“I’ll tell the family,” I said next and she nodded.
Perhaps my heart pounded even more than before as I left the room. I did not see my own reflection as I disappeared into the clutch of family waiting outside his door.
“He’s gone,” I tried to say, but the words were like gravel in the back of my throat, and I don’t think I finished. They all understood immediately however, and had perhaps already known. At least four or five of them began crying aloud and immediately tears sprang into my own eyes. Several of them hugged me and most of them thanked me. I was now, again, both in the scene and detached from it. Was this being a doctor? I had done nothing of medical value for this beloved patriarch. I had no more roll in his death than I had in the sun setting, but emerging from the hospital room, it was as though I had announced the sun had set and only then did my village accept that night had fallen.
There was a remarkable, and perhaps even treasured intimacy to that moment, unknown to me then, but lodged in my memory and allowing me to retrieve it now, some 40 years later with nearly the same vivid intensity it had at the time. Connection between us as frail humans can occur in the most surprising places and for the most surprising reasons, and, without exception in my own experience, these are moments I treasure.
