Leçons De Ténèbres

Dr Mohammad Razai trained at University of Cambridge and is an Academic Clinical Fellow in Primary Care at St George’s University of London.

When the time came, I was called to witness the anguish of his soul, as he slipped in and out of consciousness. His pulse was withering away. He exhaled one last gasp of breath into the chill room. I laid my cold stethoscope on his still warm chest, there were no familiar sounds of the heart or lungs — only stillness — punctuated by rasping sound of the monitor. The dawn was breaking as I sat on a chair in the nursing bay and typed in his notes: RIP.

The man I call Steve walked into hospital in a nonchalant autumn day, days earlier, all set up for his operation. He had a brain tumour that no one knew what course it would take. He could leave it alone and hope it would not bother him too much or have it removed. He chose the latter. ‘I want to rid myself of this thing once and for all.’ He told his surgeon.

Steve’s operation took several hours but things went according to plan. He woke up, a little fuzzy and disorientated, then the effects of anaesthetic soon wore off and he started getting sharper, brighter — feeling pleased with himself that the decision to go ahead with it was indeed the right one.

Later that day he felt something strange. Unable to press the alarm, he shouted for help. There was a flurry of nervous excitement around his bed. He was shoved into a scanner — bloods taken, new lines put in, cold injections pumped into his veins…

Steve was told that he had had a stroke, a ‘serious and unfortunate’ complication. He did not remember whether he knew this when he told his surgeon: ‘I want to rid myself of this thing once and for all.’ In any case it really did not matter now because he was paraplegic.

He was living in a funny world where his days seemed all the same but looking back everything was different. The pendulum of time swung between being and nothing, “between always and never”— Zwischen Immer und Nie. Celan.

Steve was told that he was ‘medically optimised and needed rehab’ — a code word for ‘we can’t do anything more for you here and we need the bed for someone else’. Long, and at times querulous, discussions took place, some recommended nursing home others home with ‘care’. Meetings were held to determine his ‘best interest’ or rather the best that people thought for him. No one was wiser at the end of them than they were at the beginning.

The Social Care with logic of its own moved at a glacial pace — there and not elsewhere, thus and not otherwise was how days and hours passed. Steve meanwhile lay in bed paralysed, gazing at the ceiling, unable to move or selfcare without assistance. A fierce, undifferentiated reality was propelling him towards an unknown inattentive future. Time brought him new problems. Infections started appearing from nowhere, sometimes in odd places. No sooner he would be treated for one than another would raise its head.

He started getting chills, a spiralling fever, became paler, more listless — his decline was vertiginous and inexorable.

Dying in hospital was his greatest fear: ‘I don’t want to be here, send me home.’ But it was too late. Steve’s end was destined to be a sunless recess of the hospital well acquainted with such suffering.

He died alone.

And buried with him his last wish: home.

I have encountered death almost on a daily basis, but no story has been more poignant than Steve’s. Remembering death is not only witnessing and attending to it but a conscious journey of coming to terms with our precariousness. Death may not be entirely dark (even if it is) it can teach us a great deal about life and what matters in the end.

Declaration: to protect the identity of the patient, all identifying information has been removed. 

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