After death

February 26, 2015 - My colleague and I walked into a patient’s room today and found her dead. This has never happened to me before. She was an older woman (her paperwork said she was 35, but, even accounting for how hard life can be here, this is not possible – we thought maybe 65) who had come in a couple of days ago and almost certainly did not have Ebola. She had a swollen belly, a puffy face, and was having bloody bowel movements and perhaps bloody spitup, as well. Although bleeding CAN be a part of Ebola, it is relatively rare, and the rest of the symptoms don’t sound like it at all. Plus, her first blood test was negative (since the test happened within 3 days of her most recent symptoms, though, it is not considered definitive). One of my colleagues, a “hospitalist” (doctor who takes care of patients on the floor of a hospital), and thus someone much more experienced with trying to diagnose unknown conditions than I am, thinks she may have had cancer. In any case, she had been unwell for some time, it seemed to us. 

It is weird to say it, but it wasn’t an unpleasant experience. That is – I wish she hadn’t died, and I am sad for her and for her family. What I mean is – given the fact that she was dead – that it had happened, and we weren’t going to un-do it – moving her on the bed so that she was lying straight, and then pulling a shroud over her to cover her until the team that takes care of bodies could come – I was, in a very small but still real way, thankful to be able to do it. Maybe, back when we did this in the house and didn’t call in a “specialist,” many people felt that way? Or maybe it is just some quirk in me – I definitely have a kind of awe of death, the thing that “makes these odds all even.” But it can’t just be me – there are so many things in the culture – “Fear no more the heat of the sun.” Or – does anyone else have a connection to this one? – the bass aria toward the end of the St. Matthew Passion, “Mache dich, mein Herze, rein”? It’s a piece of music that doesn’t make “sense,” and yet it makes sense. It is after Jesus has been crucified, so the whole horrid story has happened – the people have turned on and failed to save the person who loves them the most; he has been tortured and killed. And then this extraordinarily peaceful – in fact, kind of happy – music starts playing, the text saying “I will bury Jesus myself.” The implication in the song is “I will bury Jesus inside me; he will continue to live in me” – but I’ve always thought that just something about the simple fact of burying him – of taking account of reality, of what has happened, and then dealing with it, straightforwardly, respectfully and kindly – might be part of it, too. After the crisis there is peace; let’s let our dealing with it allow that peace. Since I’m not part of her family – since I don’t have any knowledge of her, no personal emotional investment – maybe this little thing is something I CAN do, gracefully, at a time when it might be harder for someone close to her - ? 

In any case, the family wouldn’t be allowed to. Even though I don’t think she had Ebola, she, like all unexplained deaths here, will be treated AS IF she did – just in case. People who have died are EXTREMELY infectious – basically, if you think of dying from Ebola (as opposed to recovering from it) as being, in the end, overwhelmed by the virus, you get the picture – by the end, the virus is just running riot – you are full of it. So they err WAY on the side of caution, to prevent possible spread.

Which means that what (as I understand it) people over here consider respectful treatment of a body – washing it, preparing it – is not allowed. In fact, families cannot usually even see a “suspect” dead relative – they may sometimes be able to be present at the burial, but they must keep a good distance, and the body will be enclosed in a body bag as it is placed in the grave (in a special area, dug very deep – again, to avoid infection). I gather that this has been (not surprisingly) very, very hard for people to accept – my sense is that a not-insignificant portion of new infections comes from people who, either out of ignorance or because they just couldn’t bear to do otherwise, have taken part in ordinary funerals, instead of the “hygienic” ones that the disease demands.

So, anyway – without being able to act with any particular knowledge of this person, without the care that someone who loved her would offer, without being able to spend much time on it, but nevertheless respectfully and kindly (and without cant), I helped get her ready for burial. Like I say – I am glad of that.