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  • Writer's pictureEric Knabel

Thoughts From Six Feet Away: Time Won't Let Me

Of all the concepts that humanity has devised, time may be the most fascinating. My kids are incredibly entertained by the story of my youth, where we would call a number, often multiple times in a day, to be told what time it is, as well as what the temperature was. It seemed completely normal at the time, but in light of today’s technology, one need only look at their phone to get both pieces of information (and a multitude of others). And as the band Chicago once famously asked, does anyone really knew what time it is?

Time can be a relative concept, but one aspect of it is absolute –the moment where you have no more left. My medical training has tainted my thoughts on time forever; my colleagues and I dwell on it, trying to maximize it for all our patients. Sometimes we spend so much energy trying to add days to peoples’ lives, we forget to add life to their days. We fail to acknowledge a person’s desire to have a “quality of life,” often to battle our own inner demons; namely, if we lose a patient, it’s an indictment on our abilities. I’ve often had to consider a sobering fact when I find myself losing perspective: in my battle with Death, Death is still undefeated. My only purpose is to make the game interesting – the ultimate outcome is inevitable.

Nowhere is this more dramatic than at the very end, when the decision is made to suspend all further efforts to save the life of another. As a physician, I’ve stood at the head of many beds, expectant eyes darting furtive glances at me, everyone in the room acknowledging the inevitable, with only one human being in the room making the call, and that’s the professional who stands in my shoes, the one who will sign the death certificate. And a part of me dies every time I look at that clock, uttering my least favorite words: “Time of death, 3:42” (or whatever time it happened to be).

The first time I remember saying it was when I was a resident. A 24-year-old woman was admitted for pneumonia, and she had a history of blood clots. Knowing this, I was shocked to see that she was taking birth control pills (estrogen is a huge no-no, due to its tendency to form clots in the vulnerable), and she confided to me that she had been secretly seeing another doctor to get them, since her regular doctor refused to do so. I told her that I would have to tell her doctor, since I was covering for him that weekend, and she nodded in resignation. Later that night, the code team was summoned to her room when she went into cardiac arrest from a massive blood clot in her lungs. That night I noted the time to be 9:46pm, and it was also the night that I first had to tell a parent that their child didn’t make it, despite our best efforts.

As the age gets smaller, the psychological impact gets bigger. I once spent 45 minutes resuscitating a 4-month-old infant whose mother had put them down for a nap on their stomach – on an air mattress. The time that day was 1:45pm, and again I had to break the news to a parent, and it was one of the few days that my compassion failed me, because this child had been taken from the mother by Child Protective Services and placed with the grandmother, who then let the mother “babysit” when she had to go to the grocery store. And one day at 2:55pm, I watched in horror when an emergency C-section was done under local anesthesia (like when you get stitches), because we couldn’t find the anesthesiologist. Fetal heart sounds had been lost during a routine prenatal visit, prompting the rush to the operating room and delivery of the stillborn infant. Despite our best efforts (another phrase I’ve come to hate in medicine, because it always precedes bad news), expectant eyes again turned to me, and one of my pediatric colleagues calmly said to me, “Your call, Doctor.” Another piece of my soul, left behind in that cold, sterile space. I discussed that case recently with my wife (who was my office manager at the time), and she remembers that she didn’t have the heart to bill the grieving father for services rendered. Indeed.

Thankfully, it’s not all horror stories, even though those are the ones that stick out. If one has time to prepare, those final hours can be powerful and life-affirming. I remember a moment early in my career, during a conversation with one of the town’s bankers, where he paid me the oddest compliment I’d ever received – “I hear that when it comes to the deathbed, you have no equal.” I hope that was a compliment, anyway. Over the course of my career, I’ve held many hands, telling them it’s okay to let go. There was one kindly old man who smiled at me, put his hand on my cheek and said, “I can’t wait to tell Jesus about you today!” Even if you’re not a religious person, that’s a powerful statement. I remember another gentleman, his strength failing him, looked at me and said, “I’m glad to know you, Doc.” It was 4:03pm that day when I made that final declaration, and it was hard to say goodbye to that particular friend.

It’s a bit of a paradox, telling stories about death when one commits themselves to preserving life, but I believe that death is life’s shadow, and we are only healthy if we embrace the darkness as we do the light. And sometimes, the opportunities don’t even wait for the deathbed. I remember being home to visit a friend from high school, one of those friends where you spent at least as much time at their house as your own, especially during the summer. His mom was our grade school music teacher, and she was in the terminal stages of ovarian cancer. My friend, his parents, and I were all in the living room, sharing stories from our childhood, as we often did when we were together. His mom was enjoying the memories, but at one point her expression grew serious, and she looked me in the eye and said, “So tell me how this is going to go.” When I asked what she meant, she responded, “Dying. How is this gonna go?” It was a heavy moment, and never have I prayed harder to find the right words. I gave her the wisdom gained through (at the time) twelve years of experience, finishing with that there will be peace at the end, and it will be the easiest thing she’s ever done. The lines on her face softened and she smiled at me. “I can do that,” she said, and that was the day I taught my teacher. I don’t know what time it was for her, and I’m glad I don’t. But I’ve been told that my words meant something to her and gave her the courage to confront her own mortality.

Thankfully, in recent years I haven’t had to proclaim the time to a team of expectant co-workers. In fact, the less I know what time it is, the better.

And please, while you still have time, be excellent to each other, and...

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Sep 12, 2022

It's 3:22 PM MST and I'm crying😪

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