The Final Whistle

Medicine has a way of numbing you to death. Since the only patients you can actually see and help are the living ones, death becomes an impossible-to-conceive-of finish line. Death is, in medicine, mostly a motivating factor. If you don’t give this drug, they might die. If you do this surgery, they may not die. But we skip over thinking about death itself, and just do our best to help patients avoid it. Although this is probably useful for the self-preservation of doctors, there is a vague incompleteness to not really thinking about it.

Imagine watching a football game with incredible intensity. You study the plays in depth, analyze the different offensive and defensive patterns, learn all about the individual players… but you never actually watch the end of the game. Inexplicably, with 1 second left, you switch off the TV and turn to the next game. You do this over and over, game to game. Each game is unique, but the rules are rigid, which makes understanding the game algorithmic. You learn to start seeing patterns.

Wouldn’t you be curious about what happens after the game? How the players react? What they look like when they are off the field? You’ve become a master at decoding the various plays, but what is the meaning of this game? You’ve never seen any post-game interviews, any parades through the city. You don’t know the standings, and you don’t know who will play next. You just know how the games go.

Stranger still, what are the players even doing on the field? How did they organize themselves this way? Who put the refs in charge? Since you can’t see any pre-game either, it is just as mysterious how the players got here, and why they seem really stoked about getting first downs.

The absurdity of our situation has not escaped modern thinkers. Atheist philosopher/neuroscientist Sam Harris has an incredible and uplifting talk on this topic, called Death and the Present Moment. I have returned to this talk many times during residency to ground me against the arbitrary nature of death that is part of daily hospital life.

As I sit here in the ICU, I’m surrounded by patients hooked up to machines and medicines to prolong their lives, to extend their games for as long as possible before the inevitable final whistle. I wonder about their lives, about the infinite tapestry of human existence, each of us a single thread. I wonder what these people valued, what they spent their time on, what memories they hold closest. Were they satisfied with how their life turned out?

We are all going to die; all of our games will one day come to an end. In light of our precarious situation here on earth, making sense of my existence has been difficult. In a span of about 3 years, I’ve been everything from righteous mystic to bemused Jew to intrigued atheist. Answers are elusive, and the hard facts seem downright cold. But I’ve learned one thing for sure –  it’s a gift to even be playing the game at all.