• The Editor

How Do You Memorialize the Dead?

By Russell Prichard, MD

Emergency Medicine is strange. Walk into any ED and you will find the extremes of the human condition laid bare; unbridled grief adjacent to cautious optimism next door to outright joy. The proximity to pain and suffering brings the scene up to a fever pitch, a perfect microcosm of the species. A fundamental truth of humanity is that the opposing facets of our nature are bound together; that we are the sum of both the best AND the worst aspects of ourselves.

The simultaneous expression of this duality is especially apparent to me during transitions from life to death. Not only the obvious apposition of a single individual going from healthy to sick; but also the way people act, what they say and do in times of crisis, the connections they make. Sadly, a common aspect of this process is also something I find particularly troublesome: last words.

When I spoke to my colleagues, it seemed like I was one of the few who kept a catalog of the last things people said, and I didn’t know why. Everyone had a story—of course—but typically just one or two short examples and I had so, so many more than that. Was I really harboring so many more than my friends? Am I doomed to hoard all these painful expressions? On further reflection I realized I wasn’t keeping EVERY person’s last words… at least half I let go of unconsciously. What, then, determined the “stickiness” of a phrase; and what did I gain from it “sticking?” There must be some pattern uniting these words. How could Last Words, which ranged from devastating to sweet, terrible to funny, all seem to speak to the same underlying truth.

 “I’m not ready.”

This was said to me around 12 years ago by a middle-aged man trapped in an SUV. His car came to rest a good distance from the road, next to a row of oak trees whose leaves let diamond and trapezoid patches of light sneak past and dance across the hood.  During our interaction he had been getting increasingly agitated and confused—but God—those three words came through fierce and sharp. 

He was afraid of course, but also surprised; as though rolling your car at 80 miles per hour was something that happened to other people. His fear began to congeal, which, when mixed with the sweet smell of antifreeze and the acrid smell of hot plastic, assembled into a spectre that aimed to smother me. We cut him out of the mangled car, my colleague intubated him and he was taken by helicopter. I spoke with the flight crew a few months later, found out he was pronounced dead by the accepting hospital, and realized those words were the last thing that he ever said.

I felt like I should write it down. I wanted to tell someone who knew him. Then, laden with the obvious futility of telling a loved one a phrase that would only bring more pain, I strove to forget it. Forgetting was a task I was unequal to; and it was stored away in my subconscious where it still springs up from time to time. My memory of his face is gone, but his last words remain because I am their keeper.

I’m just so tired, but Doc, I’ve lived a good life, I don’t want to fight anymore.

This (or something very close to this) was said to me less than a year ago by a sweet, unassuming man whose presence in the ICU was dictated by metastatic lung cancer and severe COPD requiring a constant torrent of oxygen into his nose. There, trapped by machines BUT surrounded by his doting family, he passed in the early evening as the sunset made the building across from his window sing in golden tones. I don’t know if the above are an exact reflection of his words, but I don’t think that it matters. I wasn’t compelled to hold onto them.

Some words stick, others evaporate. The first speaker had not come to terms with his mortality. My emotional link to him binds me to the time of illness and I never saw him when he was healthy. He will never say another thing and I can’t know if he left with any semblance of resolve. I can’t convince him that his life was beautiful, not for its grandeur but precisely because it was imperfect and transient. But he didn’t know that.

So I carry his words around.

You may ask, as I have, what is the point of holding onto something burdensome? What will become of these words after I die? Obviously, the words will die with me. Though, the truth is that they are not his words anymore, they are mine. I am their Keeper. But still, the real question I ask myself is, Why?

I think that deep down, I hope that remembering these words will make me a better human by forcing me to consider my own mortality. That by accepting the speaker and finding love for them at the end of their life, I can accept and find love for myself. I hope that it helps me to see that, in simple economic terms: the real value of human life comes from its scarcity, that it is glorious because it is brief. I pray that eventually I will come to see myself as I see them; a fragile, strong, hideous, beautiful, duplicitous spirit capable of both the greatest evils and the purest good. Maybe by the time I’m ready to speak for the last time I will have found the peace I wish I could have given him.

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