COMMENTARY

The Peculiar Timing of Death

Mark E. Williams, MD

Disclosures

July 14, 2021

I have spent my entire career in geriatric medicine. But a lesson I learned early on as an intern has served as a guiding reminder throughout my career.

Mark E. Williams, MD

It was the third month of my internal medicine internship on the oncology service, and I was one of two interns on an every-other-day on-call schedule. Each day one of us was telling the other what needed to be monitored and what had happened during the course of the day.

During this particular rotation, I was paired with an intern doing 1 year of his internal medicine training before going into an anesthesia residency. One cool September night he was signing out his patients to me.

"I got the path report back on Ms Brown," he said.

I remembered Ms Brown, a 26-year-old woman who had come in with significant abdominal pain and weight loss. She and I were the same age.

"She has a gastric malignancy," he said. "She will be dead in 6 months."

That sad and tragic thought sunk in as I started the evening's work. I decided to go see her. She and I talked for a bit; she was philosophical and said that she thought the news would be bad.

Not long after that conversation, the chief resident paged me and asked me to meet him in the emergency room. I thought he was going to share a new admission, but instead he had a grim look on his face when I arrived.

"You may need to be on call again tomorrow night," he said.

"Okay, let me call my wife so she'll know I won't be coming home," I said. "What's up?"

We went to a room in the far corner of the unit with the curtains pulled. Lying on the gurney was the mangled body of the intern who had signed out his patients to me less than an hour earlier. He had been killed in an automobile accident shortly after leaving the hospital. I was probably the last person he had seen before he died.

The juxtaposition between his statement to me about the patient who had only 6 months to live with the fact that he had only about 15 or 20 minutes of life remaining indelibly branded itself into my awareness. I realized that our lives are always vulnerable to ending at any time and none of us has any guarantees. We really need to enjoy each moment while we can.

A Lesson Revisited

I've told this story to medical students and residents many times over the years to impress on them the importance of keeping our affairs up-to-date. Also, when we say goodbye to our families, we should treat it like it's a real goodbye. While we know that the law of probability of a safe return is in our favor, we have no guarantees. So, when we return it should be a thankful, joyous reunion.

One day, I was sharing the story of the intern with a group of medical students during nursing home rounds. They were particularly interested in discussing how our lives can be so fragile and transient. One student was especially active and articulate in the discussion.

I was stunned, then, to learn days later that this student had died the day after our conversation. He had dropped dead during a race for charity. The autopsy showed that he had hypertrophic cardiomyopathy and most likely died from dehydration.

Upon Reflection…

When I reconvened with the small group of medical students following their fellow student's death, we all acknowledged a fresh and somber appreciation for the fact that tomorrow is not guaranteed. Whether we work in geriatrics and palliative care or any other specialty, this important life lesson should never be far from our minds. I can tell you that it is never far from my mind as I remember to celebrate each and every day.

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