Death has always had a special horror for me. I know I’m not alone in that feeling. I realize that we’ve all been “dead” for the eternity before we were born – and will resume that state after our relatively short lives are over. But knowing that fact doesn’t allay the innate horror that wells up from deep within our brain when we see death firsthand, since we identify with another’s death which mirrors our own that will occur at an unknown but too-sort time in the future.

There’s nothing we can do about death, except stave it off. I guess that’s one reason I entered medicine – to fight the good fight that we all wage against the grim reaper. Non-physicians try to elude the reaper. As a physician I could fight it. A noble endeavor, perhaps.

So a physician’s first encounter with a patient’s death is similar to a GI’s first contact with the enemy, a horribly strong foe that will kill us all eventually. It humbles us and impresses us and first impressions are lasting. The death encounter lives on in each physician’s active memory.

My first encounter with death occurred in Glasgow, Scotland in 1970. I had started my first clinical rotation as a medical student at the Royal Infirmary. I’d been assigned to the cardiology ward, which was a huge open room with tall ceilings and natural light. Our patients’ beds were lined up against the walls and there was no privacy, except for transluscent curtains that the nurses could draw around a bed for privacy. The patients, mostly older gentlemen, seemed quite accustomed to this open ward situation and were very considerate of each other’s peace and quiet. After the nurses administered the bedtime medications, each patient turned out his light and was still.

I was assigned to do an intake history and physical exam for a distinguished-looking 80-year-old Scottish man. He’d had a sudden crushing chest pressure that felt “like there’s this elephant that’s come sit on my chest.” We partially relieved his pain with nitroglycerine and morphine. But it was clear that he’d suffered a massive myocardial infarction (heart attack) and was having serious cardiac rhythm problems and congestive heart failure. He was dyspneic (short of breath) when lying down, his lungs filling with fluid. So we propped him up and gave him oxygen, lidocaine, digoxin, and diuretics. This relieved his dyspnea such that he could speak. Through all this, he remained an incredibly good sport. He maintained a twinkle in his eye and, perhaps because of the narcotics, he proceeded to regale his American medical student with stories of is life. He told me about his his clan – his wonderful wife (who had died a year earlier), their children, and grandchildren.

The next morning, after our ward rounds, I met some of his extended clan who’d gathered around his bed to wish him a speedy recovery. Later that night I made evening rounds on that ward. It was entirely dark now, except for a curtain that had been drawn around my patient’s bed and lit from within by his wall light. The ward was completely still, except for a nurse who was softly singing a Scottish melody behind his curtain. Thinking this a bit odd, I peeked inside the curtain. My patient was dead!! And his nurse was cleaning his body. I was horrified, since I’d just spoken to him earlier that day and he had been so alive. I was shocked and angry. Death had won. And I immediately thought to myself: “Why is this nurse singing? Doesn’t she have respect for the dead?” That thought vanished when she felt my presence and turned to me, smiled sweetly and whispered in her thick Scottish brogue “He had a fine life, didn’t he now.” All I could do was nod my head in agreement. I just listened as she continued her song. I think it was a lullaby.