ALL doctors must regularly confront the fact of the end of life. I have some standout memories of my own, and I should warn you that some of these are quite distressing.
The first was when I was a very junior doctor, about 18 months into my career. The patient, a man in his sixties, was unable to keep his food down and had lost weight. He almost certainly had stomach cancer. But those were the days before technology provided CT, ultrasound and MRI scans, so a common operation was a laparotomy, that is ‘take a look and see’. (These days no surgeon will open an abdomen without knowing exactly what they will find). This patient proved to be an ‘open and closed’ case since the cancer had spread everywhere and was completely inoperable.
One evening when he was recovering from the surgery, he asked me when I thought he would start to get better. Now his family, who had been given the news, were emphatic that he should not be told. This is quite common and reflects their own difficulty in coming to terms with, to them, an unbearable reality. But this was the first time in my fledgling career that I had faced such a dilemma. I decided, inexperienced as I was, that I would not lie to him. After all, his approaching end of life was a hugely significant event, so why should he not be told? Therefore, I quietly suggested to him that he should consider the possibility that he would not recover. After a short pause he asked the obvious unanswerable question, ‘How long, Doc?’ The family were furious, and made a formal complaint to my consultant who, to his credit, fully backed me. I do not know whether the patient made his peace with his family, or God, but he died shortly after.
The next case, at the opposite end of the scale, happened when I was a casualty officer, again only with a few years’ experience. Casualty departments were very differently staffed in those days with more junior doctors in the front line (an utterly stupid arrangement). We were informed by ambulance control that a ‘blue-light’ case was on its way, a child with a cardiac condition. The crash team assembled, and a boy of about ten years was rushed into resus. He had a large scar down the front of his chest, evidence of previous cardiac surgery, although we had no details. The team worked on him for about an hour, but to no effect, and the decision was made to pronounce the lad dead. Then all the more senior staff went away, leaving it to me to speak to the parents, which was quite inappropriate.
They stood up as I entered the room, and when I had given them the news his mother slumped back in the chair and simply said, ‘After all we’ve been through.’ These five words conveyed a story of years of anguish, fear, but also anger and dashed hopes; what else I can hardly imagine. I lacked the words then, and probably still do so now. I suggest you read the recent moving article in TCW by Paul Collits on the death of his daughter. Every young doctor must eventually face the question, can I cope with this? Like many, I probably became relatively emotionally detached, which explains why these memories are returning to haunt me.
The third case is that of a boy of six years. I first came into contact with him when I reported the X-ray of his fractured arm as suspicious of non-accidental injury. A full case conference was convened, and the parents interviewed. It was decided that the explanation given for the injury was satisfactory, but for some reason the history of domestic violence by the father was not considered relevant.
The lad’s next contact with the health team was a referral to a community paediatrician. His teachers had seen him stealing food from other children’s lunch boxes and scavenging in dustbins, and he was very thin. His mother swore that at home he ate voraciously, and stole food at night from the fridge, and that clearly there was something wrong with his digestion. If he had been admitted to hospital for observation his life would have been saved. However, he was simply referred for tests, with a follow-up appointment in four weeks.
Soon after, early one morning his parents made a 999 call having found him unrousable in bed. He was dead on arrival, his body already cold. He had been beaten unconscious, starved and left to die in his bed overnight in a room shared with his sister. We were asked by the coroner to perform a postmortem CT scan which demonstrated his catastrophic head injury and many others such as fractured ribs. The memory of his emaciated body, and the look of despair on his gaunt little face will never leave me. Subsequently both his parents died in prison, one from natural causes having refused treatment, and the other by suicide. As a Christian who takes the words of Christ seriously, I believe that they will face a far more serious judgment than any on earth can deliver.
You may be wondering where I am going with these sad stories of sorrow and bereavement, which of course all of us have experienced from time to time. The answer is in the lead-up to Easter, a time when Christians all over the world meditate on life, death and resurrection. However, I am focusing not on the Passion of Christ, but on the account of the raising of Lazarus as told in John’s Gospel. I realise that non-believers may be very sceptical of the story and dismiss it as fiction or myth. However, if you read it honestly, and the Gospels were a written in a unique style, unknown until that time, it has all the hallmarks of an eye-witness account. The author C S Lewis, in his article ‘Fern Seed and Elephants’ based on a lecture to theological students, states, ‘I have been reading poems, romances, vision-literature, legends, myths all my life. I know what they are like. I know that not one of them is like this.’ Read it in John chapter 11 and decide for yourself.
The account focuses on Christ’s divine nature, but also his humanity. His divine nature is obvious. One who could stand before an open tomb and command a dead man to come out would be, to paraphrase C S Lewis again, mad, bad or God, and the testimony is that Lazarus came out, still clad in his grave clothes. However, his humanity is seen in his grief at the death of a close friend whom he loved, and the grief of the sisters and others. The text records the shortest verse in the bible, ‘Jesus wept.’
It is a legitimate question to ask why he was so grieved when he had already stated to his disciples that Lazarus was to be raised? The answer surely is that while identifying with the grief of the family, he was looking forward through time to see the pain, grief and indeed anger at the devastating effects of sin and death which would affect all humanity. Indeed, these words go right into the heart of the compassion of the Triune God. The murder of the little boy by his sadistic parents – Jesus wept! The murder of three little girls in Southport – Jesus wept! The grief and tears of tens of thousands of wives and mothers whose husbands and sons have been slaughtered in Putin’s pointless war – Jesus wept! Obviously I could go on for ever.
Of course it did not end with tears alone, but with action which took Christ to the cross on Good Friday where he bore the wrath of God the Father for the sins of the world. His death cry, ‘It is finished’, confirmed that the purpose of his incarnation had been fulfilled, and as he died it is told that the veil in the temple in Jerusalem, symbolising the separation of sinful mankind from a holy God, was torn from top to bottom to show that the way back to God was now open through faith.
Christ’s words at the tomb of Lazarus, ‘I am the resurrection and the life,’ the last and possibly greatest of the seven ‘I am’ statements in John’s Gospel, a direct reference to the name of God in the Old Testament, are probably the most significant and hopeful words ever spoken, and it is this we celebrate on Easter Sunday when the disciples found the tomb empty. Death, the last enemy, had been defeated.
So, as our children gorge on too much chocolate, and as many celebrate Easter Sunday lunch with roast lamb, it would be worth reflecting on the words of John the Baptist at the start of Christ’s ministry, ‘Behold the Lamb of God who takes away the sin of the world.’
