The last gaze: witnessing a peaceful death 

The double-doors swung open, and I crossed the threshold that separated the rest of the world from the ordered and chaotic society of the MICU. Night had already fallen outside, and light shone out the unit windows into a rainy Baltimore sky. Down the hall, the day shift intern hunched over a workstation-on-wheels outside of a patient room—an ominous sign that something was wrong. Across the floor, the senior resident spoke in hushed tones to two well dressed women. I quickly learned about our new patient—she had arrived less than an hour ago and she was dying fast. 

One of the biggest shocks for new residents is dealing with death. As medical students, we are largely sheltered from dying patients and the related challenging discussions. Most, if not all, interns feel woefully unprepared to navigate these moments of mortality, and our early experiences are often burned into our memories, for better or for worse. Stories of patient deaths that were perceived as traumatic, painful, or existentially bothersome, prompt us to wrestle with our own beliefs around death, dying, the afterlife, and desires for last days. What do we see as a “good death”?  

When pondering a difficult clinical question, any physician worth their salt will turn to the literature for the investigations and expert opinions of peers. While there may be no randomized control trial assessing dying well, we can look to the writings of one of the most esteemed physicians in contemporary medicine: Abraham Verghese. Dr. Verghese, famous for his bedside medicine initiatives at Stanford and recent international headlines for his new novel, “The Covenant of Water,” meditated extensively on death and dying in his debut novel, “Cutting for Stone.”  

“Cutting for Stone” is difficult to describe in brief, as something so magnificent and grand in scope makes any attempt at summary feel criminal. Suffice it to say that this story is about individuals and communities, life and death, the immigrant experience, as well as the joys and trials of the medical profession. When death is portrayed, which it does several times, it is a grounded perspective. 

Most of the deaths in this novel are poignant in their tragedy, something any physician can relate to. However, for me, one vignette stands out from the rest, a sort of icon of a good death—that of the protagonist’s foster father, an internist named Ghosh. Verghese paints an image of Ghosh’s final moments—the doctor sits at home, sons holding his left hand, old friend holding his right, resting his head on his wife’s body while a pious friend, lean from days of fasting, and a priest, stand nearby praying. Ghosh opens his eyes and looks upon his loved ones. Verghese writes, “I like to think in that last gaze he saw a tableau of his family, his real flesh and blood . . . I like to think in seeing us he felt his highest purpose was served. And that is how he passed from this life to the next, without fanfare, with characteristic simplicity, fearless, opening his eyes that last time to make sure we were fine before he went on.”  

With impressive brevity and deftness, Verghese conveys numerous facets of a good death: the presence of a loving family (a love that is the product of a life well-lived), the familiar and meaningful context of the home, spiritual intercession, individual courage, and the tranquility that comes from leaving loved ones well cared for.  

Back in our ICU, there was no intervention that we could offer our patient which would meaningfully prolong her time. Calls were made, and within 30 minutes, a dozen family members gathered in her room to say goodbye. The on-call priest arrived, black book of prayers in hand, and gathered the family at her bedside. Voices were raised in unison as she was anointed. She passed minutes later, surrounded by her loving family.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.