The Mortal Doctor

I will always remember the first time I saw someone die. I was a medical student working in the emergency room of a small, quiet hospital, and it was late at night. An ambulance pulled up with sirens blaring, and they wheeled an old man into the trauma bay while giving him chest compressions. I followed the doctor into the room and prepared to take a turn giving chest compressions, but before my turn came the doctor pronounced him dead and halted resuscitative efforts.

The emergency medical personnel quickly cleared out of the room, leaving me and the doctor alone. She looked at me, and then also walked away. I stared at the dead body on the gurney in front of me, and slowly walked towards it. What had happened here? Was this man really dead? He was not moving. He was not breathing. He did not respond to painful stimuli. His eyes had no pupillary response and no oculocephalic reflex. But his body was warm. Is this what death looked like? A  few minutes later I watched from a nearby desk as this man’s wife came to his bedside and cried for him. Yes, I thought. This man was a real human being just a few minutes ago. A real man with people he loved and people who loved him. Now he was gone, and there was nothing anyone in the world could do to change that fact.

Practicing medicine places doctors in close proximity to death and dying.  We witness death more often than most people do, but we are not mere spectators. We have the knowledge and the power to intervene, and can often influence the speed and timing of the event, and the patient’s experience during the dying process. I consider it a great privilege and responsibility to help patients during this vulnerable time which is often a frightening experience for them.

In the October 2015 General Conference President Russel M. Nelson and Elder Dale G. Renlund both shared experiences about having patients who died. I was struck by how similar these two stories were. I will quote both of them here, beginning with President Nelson:

Fifty-eight years ago I was asked to operate upon a little girl, gravely ill from congenital heart disease. Her older brother had previously died of a similar condition. Her parents pleaded for help. I was not optimistic about the outcome but vowed to do all in my power to save her life. Despite my best efforts, the child died. Later, the same parents brought another daughter to me, then just 16 months old, also born with a malformed heart. Again, at their request, I performed an operation. This child also died. This third heartbreaking loss in one family literally undid me.

I went home grief stricken. I threw myself upon our living room floor and cried all night long. Dantzel stayed by my side, listening as I repeatedly declared that I would never perform another heart operation. Then, around 5:00 in the morning, Dantzel looked at me and lovingly asked, “Are you finished crying? Then get dressed. Go back to the lab. Go to work! You need to learn more. If you quit now, others will have to painfully learn what you already know.”

Oh, how I needed my wife’s vision, grit, and love! I went back to work and learned more. If it weren’t for Dantzel’s inspired prodding, I would not have pursued open-heart surgery and would not have been prepared to do the operation in 1972 that saved the life of President Spencer W. Kimball.”

I can pay a similar tribute to my own wife Marisa, whose confidence in my potential was often greater than my own. During my undergraduate studies I was often filled with uncertainty and self-doubt about my application to medical school, and I have often thought that I would not have had the courage to apply if she had not expected me to. I don’t expect that any man can reach his full potential without the help and encouragement of his wife.

Early in my undergraduate studies I attended a meeting where President Nelson was the guest speaker. He spoke about his many years of education, and mentioned how some people had questioned his chosen career path because the training was so long and demanding. As I recall, his reply to them went something like this: “Yes, it will take 8 years of additional training for me to become a cardiac surgeon, but those 8 years will come and go whether I do the training or not. And at the end of those 8 years I want to be a cardiac surgeon.” This comment had a powerful effect on my attitude, and soon after this meeting I decided that I would also study medicine.

Elder Renlund was called as a new apostle in the October 2015 General Conference. Prior to his calling as a general authority he was a cardiologist who specialized in heart failure and the medical management of heart transplant patients. Here is the story he shared:

In 1986 a young man named Chad developed heart failure and received a heart transplant. He did very well for a decade and a half. Chad did all he could to stay healthy and live as normal a life as possible. He served a mission, worked, and was a devoted son to his parents. The last few years of his life, though, were challenging, and he was in and out of the hospital frequently.

One evening, he was brought to the hospital’s emergency department in full cardiac arrest. My associates and I worked for a long time to restore his circulation. Finally, it became clear that Chad could not be revived. We stopped our futile efforts, and I declared him dead. Although sad and disappointed, I maintained a professional attitude. I thought to myself, “Chad has had good care. He has had many more years of life than he otherwise would have had.” That emotional distance soon shattered as his parents came into the emergency room bay and saw their deceased son lying on a stretcher. In that moment, I saw Chad through his mother’s and father’s eyes. I saw the great hopes and expectations they had had for him, the desire they had had that he would live just a little bit longer and a little bit better. With this realization, I began to weep. In an ironic reversal of roles and in an act of kindness I will never forget, Chad’s parents comforted me.”

All doctors have experiences like this from time to time, although not always so dramatic. It is easy to think of patients as “machines” that need a “tune-up,” and we are good at prescribing a pill for this and a pill for that. But from time to time we are reminded that patients are human beings, with loved ones and with “great hopes and expectations.” They are all children of God, who loves every one of them. Elder Renlund encourages us to see other people as God sees them, which will help us to love and serve them, and to understand just how precious their souls really are.

Death is a part of life, and is a necessary step in the plan of salvation, but we believe that the death of the body is not the end of life. The spirit continues to live, and the power of Jesus Christ will bring immortality to every soul through the resurrection. For Latter-day Saints there is sadness in death, but that sadness is overshadowed by the joy of knowing that there is life beyond the grave (see 1 Corinthians 15:19-22, compare with Alma 11:42-45). Having a belief about what comes after death definitely influences the way I counsel patients on the subject, especially for those whose beliefs are similar to mine.

President Nelson and Elder Renlund remind us through their experiences that doctors are not omnipotent, and that our best efforts cannot prevent the death of all patients. But we can be assured that all people are in God’s hands, and he can use us as tools to save the lives of people who need to live a bit longer. I thank God that he inspired me to become a doctor, and I hope to be true to the trust this places in me.

Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.

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