The corridoes of pnmit chet by me

Medicine teaches that asystole after doing effetive CPR with 15 compressions and 2 breathes with a lack of pulse means that the patient has expired. I have not yet been involved in this part of the physician's job for which I have been traied, dread and continously rehearse in my head in any uncertain situation, thinking that if a physician is there, s/he should know what to do and save someone's life.

The first time that I witnessed a death after a failed CPR was vicariously. I was on pnimit chet, in one room, waiting for a doctor to finish his round so that I could ask him a question about a patient of mine who was on that ward. I had been following that patient up since having seen him in the emergency room, and was told that he was a usual "chronic abdominal pain", possibly malingering. Still, I did not want to give up on my patient.

Standing near the group of doctor rounding, looking at an old patient in bed, listening to the discussion in Hebrew, behind me, another group of physicians dressed in white coats walked out. By the lifeless look on their faces and heavy footsteps, I intuitively knew something was different in that room. I was not familiar with the patients on the ward and was only there to check on my own patient. A few minutes later, two women ran into the room, passed me, removed a closed curtain, and one women threw herself on the floor, crying, sobbing, very loudly.

I finally dared to look beyond the curtain that was removed, a man in his fifties was dead, perhaps due to cardiovascular reasons, whether he also was an oncologic patient, I cannot remember. He lied there, at the corner of the bed, with blood still present in his own warm body, and yet, he was lifeless. The medical team had walked away from a failed resusiciation. And now the family members were mourning. I later went into the medical personnel's room, and heard small chatter, "He died too young, perhaps there was a mistake we made and we could have saved him." I write those words in one sentence today, and yet I heard them intermittently as I flipped through my own patient's chart.

I remember leaving the room where the man was pronounced dead very quietly, having collected myself, and taken in a deep breath in, hoping to protect my own breath from lifeless death. And, I never thought about it again, until today when my own parents called me, telling me that a family friend's mother passed away on sunday (today is monday).

I had known the family friend since coming to Beer Sheva three years ago. She is a mother of three, and I frequented her house, either to have a drink, to help with her child's homework, or to just chat. My last visit to her house, I remember her being not as lively and as optimistic as usual. And being the corward that I am, who is not able to bring things up to people, who is too afraid and too insecure to approach people's feelings and experiences, I sipped my coffee, and helped the mother with her homework for a test.

Much like having collected the news about the patient that died on the ward in pieces, I also collected the pieces of informatiom about my friend's dying mother in pieces. She was diagnosed with colon cancer years ago, went into remission after therapy (which I am not sure which because i was afraid to ask), but now, the oncologist told my friend's mother that nothing could be done for her anymore. Since then, my friend noticed that her rmother changed, did not talk much on the phone, and did not cook as before, which she used to like. I have realized over the years that I lack the ability to listen to someone, and be silent, but also asking the simplest questions to understand. Much like having been trained in medeicine to expect myself to know the answers and only ask purposeful questions, I approached my friend's grief like that.

There is no place for a wandering question in search of understanding in my own world of medicine. I feel uncomfortable when people talk about their feelings, especially in critical moments, such as death and dying.

I left my friend's house thinking, "Well, perhaps her mother does not have to suffer. She told me her mother is in pain. What can I do as a medical personnel?" Memories of the suffering of both my grandparents, sitty Im Saleem and Sido, came to mind, and how I wished that we had been able to provide relief from their pain and suffering. I contacted a family doctor in the negev who does palliative care, met with him, asked him how to approach my friend, what to ask, how to help her mother who was in pain, in the context of the Arab culture.

Dr. Yoram sat in his chair in the faculty building, listening to me quietly. He, then, said that not everything is connected to culture, that each individual values certain things and would like to keep them, and about that he asked his patients. I left knowing that I also had those questions for my friend about her mother, and then from there, perhaps palliative care could be provided.

A few days later, after fearing the phone call with my friend, I called her, told her what the doctor told me, and she said that she was going to get back to me. I never called her back again, even though she and her mother came through my mind, but I was too afraid to ask again, in the face of my friend's overwhelming sadness and hard situation that I could not fix, or explain or change.

And today, my mother called me, reminding me of the never ending rehearsal of emergency CPR i do in my head and try to forget about, "Her mother's died. You are near Nazareth, you should go." In the face of a death and a loss that were so familiar to me on the hospital ward, I was even more afraid. Why didnt I call my friend over time? Why didnt I check on her mother? And, if i call her now, what will I tell her on the phone? I am still afraid of facing my feelings, and people's feelings and life-events.

"The burial is at 4pm in the Orthodox church in Nazareth," a family friend answered me on the phone. It is almost easier for me to remain far away, not to see my friend grief. Have I not stayed away the past few weeks? And, as I am doing a family rotation, I am coming to perhaps appreciate that death does not spare anyone, and that instead of walking away from it with cold feet like the medical team did on pnimit chet, I should perhaps approach it, silentely, in awe, and give myself to this part of life, and put my fear aside. In the face of war and conflict, courage is being afraid and yet not giving in to fear of the highly inevitable but still going through till the very end, regardless of the outcome, of the myriad of feelings that are hard to contain, comprehend.

I would like to be courageous, rather than have fear of what I dont understand and perhaps will never understand rule over me. I am going to my friend's mother's funeral, because I dont want to be afraid anymore and yet will forever embrace my feeling of awe and wonder. I am bold to say: I dont understand. Maybe I never will, but I am fully present, to tell the stories, hence by being a witness, becoming a story-teller.