In the third year of medical school we were on the hospital wards, taking care of people, supervised by interns, residents and the attending physicians. We'd had one year of normal anatomy, physiology, biochemistry and one year of abnormal anatomy, pathology, microbiology, everything that could go wrong. Now we were to learn on our feet, from live people, patients, people who were sick. I was seeking my education, but it wasn't always the traditional one for medical students. Sometimes I ventured into areas that were apparently not traditional. I was always surprised when I sought information that seemed logical to me, and found myself treated like a lunatic.

One night I overheard the nurses saying that a patient was dying. He was not my patient. They said that he was expected to die that evening. He didn't seem to be suffering.

I went to the nurses. "Can I sit in the room? Of the man who is dying?"

They gave me that lunatic look.

I attempted to explain. "I've never seen someone die. He's expected to die and he's being kept comfortable. I just think that it is part of being a doctor. I would be respectful."

The lunatic look was still there. But the charge nurse sighed and said, "You'll have to get permission from his doctor and the family. Here's the number." I called the family and the doctor. The family was grief stricken and nothing seemed particularly weird to them. The doctors had already failed them. The doctor thought it was irregular but was too tired to really care, "Go ahead."

I sat in the room. I introduced myself to the man, not knowing if he could hear me, and thanked him. I was the only one there. It was very quiet. He took each breath with some effort, but it was not loud. The nurses would stop in every so often, giving me a wary look and checking that he seemed comfortable.

Slowly his breathing became more irregular and then spaced out further and further, and then stopped. I waited. At last I was sure and called the nurse. She notified his physician and he was pronounced dead. I thanked the nurses and thanked him as well. I felt as if I'd been in the presence of a mystery; yet a mystery with no one there. No fanfare, no religious ceremony, no wailing nor tearing of clothes. Just an elderly man, who slipped away as expected on a quiet hospital ward.

My presence was unexpected. The nurses were quite clear that medical students didn't ask this, didn't do this. I felt that it was important, to acknowledge death, to greet it, to sit in the presence with respect and to say farewell as people embark on the journey that we do not understand. If I don't acknowledge the dying, how can I be present for the living?

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