Sitting Shiva
All loss deserves shiva.
Introduction
The first person I ever watched die was named Mary Jones. Mary. Jones. So common I could hardly believe it. So common that it almost feels made up*. It was as if the universe were making a cruel joke about the unifying nature of death – that it comes for The Everyman and every man. A few days after she died, I tried to look up her obituary to learn more of her life than her cause of death (cardiac arrest). I couldn’t find it, but I did find another woman named Mary Jones who died five days after her.
Despite this being over three years in the past, I can still picture everything about her code. The room number, the thick Rhode Island accent of the paramedic giving report. Found collapsed at her nursing home, asystolic for almost an hour by the time she gets to us. Mary is wheeled through the hospital completely naked and strapped to a LUCAS performing compressions so violently I think her ribs must surely be caving in. A swarm of bodies surround her, gaining access, pushing epi, intubating. The LUCAS is turned off for a pulse check, no pulse, “shock her”, everyone steps back with their hands up, “clear!”, a shock. Over and over and over until… “CPR called secondary to futility.” A moment of silence.
Mary was the first person I watched die, but she was not my first experience with death. That was my Uncle Sydney. I was ten when he died, and though I don’t really remember him, I do vividly remember sitting shiva for him in his sister’s Queens apartment.
In Judaism, shiva is a seven-day period following the death of a loved one in which you are meant to focus on your loss. There are traditions to help you feel the full force of your grief – the phrase “sitting” shiva derives its name from the custom of sitting on small, intentionally uncomfortable wooden stools while you mourn. Before burial, you rend clothing to channel your anger in an act called keriah. Those close to you bring you food so you do not have to take time away from your grief to cook. You pour water over your hands in ceremonial cleansing before entering the home of the deceased. So you think not of yourself and only of your grief, you cover all the mirrors. Everything is arranged such that grief is the only task.
I was the youngest person at Uncle Sydney’s shiva, probably by a few decades. I remember quickly escaping the living room’s air, thick with cold cream and malaise, for the deli spread in the kitchen. Eating Lipton soup and having my first existential crisis. I did not know Uncle Sydney very well, but I did know him. He was there, and then he was not, and I could not grasp what it meant for someone to be suddenly plucked from existence. Does anyone understand what the number zero actually means?
Shortly after Mary’s death, we are pulled into another code. My hands are shaking, and I tear through two pairs of gloves trying to put them on. There’s my keriah. When I finally have a few minutes between patients, I run to the bathroom and, after doubling over, run cold water over my wrists. There’s my ceremonial cleansing. On the bus ride home after my shift, I cry quietly behind my mask, resting my hand on the window so I do not see my own reflection.
At night, I try to sit some proper version of shiva for Mary. (Mary Jones? Probably Protestant, but I suppose she won’t know the difference now.) I close my eyes, put my hand to my chest, and start the mourner’s Kaddish. Yitgadal v’yitkadash sh’meih raba… I realize I do not actually know the mourner’s Kaddish. I, a long-time atheist, am pretty sure I’ve just said something like “God is exalted.”
I know the Allen Ginsberg version better.
Farewell / with your sagging belly…
In her late 90s, she did have quite the sagging belly, didn’t she?
Call the Doctor. Phone the home in pines. Too late…
It probably was too late by the time her nursing home called us, really.
What came is gone forever every time…
Maybe it will all become clear to me one day. A few more years of training, and I will learn how to stand against the unyielding waves without getting pulled under. But right now, I am sitting, spitting up bastardized phrases of Kaddish, trying to be so soft and so hard all at once.
Call that futility.
During preclinical years, everyone at my medical school had to take a course called Doctoring on the practical and emotional aspects of patient care. In it, we learned how to take a blood pressure, to counsel a patient on opiate use, to tell a patient they were dying. For difficult conversations, we were given a checklist with the mnemonic GUIDE: Get ready, Understand, Inform, Demonstrate empathy, Equip.
I once found the “Demonstrate empathy” box to be nothing short of ridiculous. I was not worried I would fail to show enough empathy; I thought, what kind of physician is concerned with such a thing? My problem was that I could not control my torrential emotions. When a patient cried, I cried. In anatomy lab, I cradled my cadaver’s heart in my hands and placed it in front of my chest in line with my own.
What I did not understand then was that with enough time and without intention, the full force of my emotions would indeed be muzzled. Since Mary Jones, I’ve seen dozens more similarly elderly patients pass after heroic resuscitative efforts. I’ve also seen a previously healthy 40-year-old man brain-dead after a fall down some stairs. I’ve seen a woman just a few days older than me, after losing her father and sister within one year, succumb to an opioid overdose. I’ve watched my colleagues code a 12-year-old girl for an hour, just to have her still die, her parents wailing something primal from the foot of the bed. Now, just a few days ago, I did chest compressions on another person just like Mary Jones, who was pronounced shortly after arrival. This time, the only thing I felt was guilt over my utter lack of feeling. I succeeded in not being pulled under the unyielding waves, but in doing so, I became stone.
Everyone says medical school is hard, and I agree. This is not so much, like I expected, because of the immense volume of information we must memorize or the long hours or the important milestones we miss while at the hospital. What has been the hardest is that while we are learning how to take care of patients, there is little room to learn how to take care of ourselves. I have never been taught how to handle the emotional residue, only shown how empathy slowly erodes, until the moment of silence becomes almost infinitesimal. After many of these losses, I went straight to another patient or class or UWorld question bank. No time to process. No weeklong break. No Lipton soup to sip in silence.
But I think all loss deserves shiva. A patient, a pet, a part of yourself lost to age or illness or circumstance. Yet in healthcare, the world never stops for you. The clothes must be washed, the lectures pile up, the patients keep getting sick. I wish I could take a week each time I lose someone or something important. And I wish I could offer some solution, rather than waxing poetic about the meaning of loss. But I cannot. What I do know is that until we build a medical training system that makes room for the full force of grief, I will settle for something smaller.
For sitting shiva in a bus seat.
For running cold water over my hands in a hospital sink.
Names and details have been changed to protect patient privacy. While Mary Jones is not actually the real name of the person in this piece, it indeed carries the same spirit.