Mortal responsibility

Pham-BannerIf you know anything about me, you probably know that I love to read. As a kid, I was what you could call a “half-tomboy/half-bookworm.” I could usually be found doing either one of two things: rolling around in the water or engulfing myself into whatever book I had my nose in that day.

Expectedly, as I began refining my intellectual pursuits, my personal reading choices concurrently evolved. As I got older, I nurtured a deeper interest in nonfiction, albeit my love for historical fiction, and eventually stumbled upon the world of medical nonfiction. Instantly I became enamored with the written works of Abraham Verghese, Atul Gawande and most recently, Paul Kalanithi. Each author’s prose is built upon his own personal experience, and the pages are filled with clinical stories and perspectives that are all so uniquely articulated. Their narratives allow readers into their minds, allowing us to observe their thoughts and to listen to their inner monologues; through their voices I learn what fuels them, what inspires them and why they practice medicine. Despite their narrative differences, perhaps what I appreciate most about these authors/physicians is their overall commitment to viscerally capturing the moral, ethical and practical hurdles that health practitioners inevitably face when dealing with life-threatening situations. What makes these individuals remarkable is their natural ability to articulate these situations with eloquence (and impeccable word choice), leaving me inspired to cultivate my own nursing practice with a similar sense of poise and relentless passion.

Up until very recently, these moral dilemmas I read about were hardly a reality; facing death was never something I contemplated seriously. I mean, I had always understood that death is inevitable– a rite of passage, so to speak. However, it was nonetheless hypothetical, a life event that would eventually happen some day, after I had lived a long, fruitful life of experience and contentment.

This changed very quickly several weeks ago. I was driving home after dinner with a friend, and a moped driver recklessly made an unprotected left turn across a line of traffic. Although I had the right of way going straight, neither of us saw the other, and I t-boned him. The moped driver instinctively jumped off of his moped to clear his leg from the collision with my bumper, instead somersaulting onto the hood of my car and falling violently onto my windshield. Judging by the force of the impact and the hefty amount of broken glass from my vehicle, I immediately presumed that I paralyzed this individual, at the very least. He rolled off the windshield and landed on his feet, ultimately leaving the scene with nothing but a single scratch on his hand.

The few days following the accident I found myself haunted by constant flashbacks and anxiety attacks. Recounting the incident for concerned family and friends felt like I was consciously choosing to re-open a wound before it had healed completely. I was core-shaken not by what had happened, but by the potential repercussions of what could have happened. I was forced to deal with the clichéd saying that “nothing in life is permanent,” that everything can simply just end, in a matter of milliseconds. But this time, it really didn’t seem cliché anymore. What if his life had ended? What about his family? How is it that I can be responsible for the ending of a human life? Could I have done something to prevent it? Because he survived without any serious physical harm, I felt like I had somehow cheated the system, that I had somehow won a game that I did not realize I had even begun playing. I blamed myself, and began desperately searching for something, for anything, that I could have done to prevent the accident. Before this moment, I never felt that I was truly capable of severely harming an individual, and the mere fact that I actually am capable of such life threatening injure was sobering. After much reflection (and with much help from the aforementioned authors), I have come to view this experience as first-hand exposure when dealing with life-threatening situations in medical practice.

In “When Breath Becomes Air,” Paul Kalanithi says:

“Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death — it’s something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

And so I am constantly reminding myself (especially recently), that although death is inevitable, as health care practitioners, we are assuming this responsibility to care. Perhaps even more importantly, we assume the responsibility to continue caring, regardless of how hopeless or disheartening the situation may seem. We work not to starve off death, but to take into our arms people who feel hopeless, and to nurture a space where they feel empowered and enabled to face their own lives. And so, I plan to do just that. I plan to trust myself, to understand that as long as my intentions are earnest, that is all I can ask of myself. I plan to trust that I am indeed doing the very best that I can. And, as long as I am always acting from this place, the genuine intention will shine through in my practice.

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Comments

  1. Great post! I’ve also expanded my reading to medical nonfiction and have heard that Atul Gawande is amazing. Thanks for a couple of other names to add to my list.

    I liked your conclusion, too:
    “And so I am constantly reminding myself (especially recently), that although death is inevitable, as health care practitioners, we are assuming this responsibility to care.”

    Nice work.

  2. Thank you for sharing your personal encounter with this near-death experience. That must have been incredibly frightening! I think it is so humbling and sobering to realize how fragile life is. As nursing students I know we value what we are learning academically, but sometimes it is our life experience that shapes us toward becoming the best nurses. We have the opportunity to let our past, our hurts and our experiences mold us into empathetic, compassionate people who value life and care deeply for others around us. It sounds like you are doing just that!

About the Author

A native of Honolulu, Hawaii, Angelina Pham is a first-year student at the OHSU School of Nursing. She earned her first degree from UCLA in Human Biology and Society, with a concentration in Public Health. Angelina is drawn towards maternal health and health promotion. Prior to attending OHSU, she conducted several research projects working with vulnerable populations that are often overlooked. She was a part of an investigative team of an AHA-funded study that examined cardiovascular health among premenopausal women. She is also a published author in a study that analyzes comorbidities among indigenous Native American cancer patients.

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