I was the first person to admit him to the hospital, and I was the last to see him go. Rest in peace Mr. H. May you find relief at last.

It was a hot summer day, and I was busy attending to patients in the coronary care unit of the emergency department.

The ER (Emergency room) was buzzing with life, and everywhere you looked you could see residents and nurses swarming the grounds like worker bees. The ER resident came over to inform me of a patient who needed a cardiology consultation, and rushed out of the room to catch up with the new flock of patients.

I headed out to the crowded ER, dodging fellow physicians, patients and relatives on my way, until I reached the right cubicle. A man in his thirties sitting at the foot of the bed looked at me apprehensively. I hoped it was something trivial and I went about asking for the history of his symptoms. He replied that he gradually started feeling short of breath in the past few months. He noticed this because he was a manual worker, and it was getting harder for him to do his job. The rough skin on his hands was a testament to his work in plumbing.

A grim reality

Hopefully it’s nothing, I thought. After I took all the necessary steps for diagnosis, the heavy truth sunk in, he had cardiomyopathy, a disease of the heart that leaves the heart muscles weak, flabby, and unable to pump well. Dilated cardiomyopathy is a disease that leaves patients waiting for a looming death sentence, especially in places where poverty prevails and supportive interventions are deemed science fiction. I explained the cause of his symptoms and he got worried, but he didn’t truly comprehend the gravity of his illness until he became a frequent visitor of the hospital.

“Hi Mr. H, how’ve you been?” “I’m tired,” he’d say, and with every admission, he’d seem even more bloated and exhausted, and the color of his skin became slightly darker and pasty. Mr. H was a loner, he’d come alone and leave alone carrying his crinkled nylon bag of medications and a few personal belongings. The only time I saw him with someone, was along with a teenage boy whom he’d identified as family.

At times, I’d feel that he enjoyed hospital admission. I’d catch him chatting with his roommates and having a good laugh. Those were the good days. I remember snatching a bag of chips out of his hands and lecturing him about the hazards of a high salt diet. He complied when I was present, but I was pretty sure that he didn’t when I wasn’t in the room. Now that I think about it, maybe that bag of chips was one of the few things in life that gave him joy.

He’d been admitted several times throughout the year. Ever since his condition started deteriorating, his admissions became more frequent and he could no longer work. He’d arrive at the ER breathing rapidly, carrying a bag of his belongings because he knew he would need to stay.

Silent suffering

“When will I get better?” he asked with downcast eyes and an exhausted voice. He posed the question when I was hurrying to the resident’s room after coming back from a patient referral. I stood there wishing I could run away. I could feel the desperation in his voice; my heart sunk and a voice in my head whispered, he probably never will.

It was not just Mr. H; Mr. H was a name to many faces, all suffering from the same grim reality. It was those chronic patients who left me with the most pain. It was them who I’d see wilting day by day, losing color, losing energy, and losing hope. It was them whom I didn’t know how to comfort; “How could I say things would get better when I believed that wasn’t true?”— although I wished it were.

Our common destiny

I was in the middle of my shift at the ICU (Intensive care unit) on the day he was referred from the cardiology department. And he was admitted under my care. He was intubated and put on a mechanical ventilator, and I watched his body lose tone. Medications were no longer helping. CPR ( Cardiopumonary ressucitation) failed to conquer his death. His soul parted his body, and the monitor went silent. I remember a teacher once told us that medicine was a slow science. I understood that when I learned that we were still struggling to fight diseases that had plagued mankind for hundreds of years.

We cannot defy death, but we can try to alleviate suffering and improve the quality of life for everyone in pain. Death reminds us of how vulnerable we are as humans and what really matters in life. Witnessing death is a cleanser to our souls and a reminder for us to become the best versions of ourselves, but it will always be painful.