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Becoming a PA


Stilp, Emmaline

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Journal of the American Academy of Physician Assistants: February 2020 - Volume 33 - Issue 2 - p 1
doi: 10.1097/01.JAA.0000651780.30353.9a
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Death is no stranger in healthcare. It is a well-known entity, an assured endpoint—one that looms in the corner waiting to be acknowledged when the time is right. One can witness when Death enters the room and envelops those around it, holding them in its grasp until its job is through. Grief comes in soon after Death to pick up the pieces, salvage what is left, and start again. Grief and Death have a paradoxical relationship—one that not many can understand, but one that thrives in despair and loss.

Death came to meet one of my patients a few weeks back. Called Crow by his friends and family, this frail gentleman lay in his hospital bed, having been admitted for short-term observation that Death knew was going to be short in a different sense. Upon entering the room, Death acknowledged my presence but maintained its stronghold. Crow was nearing the end of his life, and it was clear that he knew Death was soon to become his friend. He could barely speak through his stridor as my preceptor and I listened while a hospice representative clarified his end-of-life wishes. Death stood near, observing. Crow knew he had to accept his fate and rescinded all care, with only a morphine drip snaking its way under the covers of his hospital sheets. He was determined to return home and pass away peacefully there, but Death was already at his bedside, waiting for Crow to agree to its plan.

Hours passed. Family and friends soon arrived, sitting at Crow's side and stroking his long, gray hair as his breathing finally grew less strained. The morphine was preparing Crow's body for its formal introduction to Death. As his heart rate and respirations slowed, Death seemed to put its hand on Crow's shoulder, telling him it was time now. Crow's body soon grew silent, Death gave the signal for Grief to intervene, and with one quick motion, the handoff was complete. Death left with Crow in tow, and Grief became a new friend to all those present.

Those present took some comfort from this devastating but skilled handoff. Those who were not present only haphazardly met Grief, not understanding its close and necessary relationship with Death. For those not present, grieving grew complicated as they did not witness Death and did not appreciate its calm, definitive necessity. They felt wronged, stripped of the one whom they loved. They postulated Death as a cold, cruel being when, in reality, Death became a comfort to Crow in his final moments and encouraged him to come along, knowing Grief could handle the rest. Although the two in tandem will never produce a “good” outcome by our standards, Death and Grief will grow to know each of us as we witness their work; they are agents of change, of pain, and of growth. Although Death's capabilities remain staggering and scary, the opportunity to appreciate its gentle work is exceptional, as Grief welcomes its interlude to embrace the patient's family and friends.

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