The Dead

20 December 2016

 
While some things a doctor does can be delegated to others, the pronouncement of death and completion of a death certificate remains firmly in our job description in most settings. In the past 24hrs, I have had to do this 9 times. This important and, in some ways, sacred job has fallen on top of overseeing the care of several hundred people on board, the intensive care of a few patients with two requiring helicopter evacuation, and helping to keep everyone on board Aquarius, a search and rescue vessel jointly operated by MSF and SOS Mediterranee, alive, sane, fed and dry in the midst of torrential downpour.
 
It has been strange to pronounce death and not have had any family members to break the bad news to. Four of the people I pronounced dead today were the only deceased people found after their large rubber dingy collapsed. Twenty-three survivors were picked up by another boat before they were ultimately transferred to Aquarius as well. The 4 dead and the testimony of the survivors is the only proof of what happened. Nobody will ever know how many were actually on that boat (though chances are good is was between 120-160 people) because smugglers do not provide us with passenger manifests. Not everyone who dies is counted and those deaths that go unnoticed haunt me.
 
In the last 24 hours, at least 200 people have died at sea. Their families will likely never know when, or how, or even if they died. Without witnesses for some of the boat tragedies, is virtually impossible for those few bodies who are recovered to be identified.
 
When I examine the dead, I try to take my time. I make sure to rest my gloved hand on their body and to say a few words to them – sometimes out loud, but often silently. “I’m so sorry my friend. I’m so so sorry. You are not alone. We care.” is often all I can verbalize without openly breaking down. I say these words because I would want someone to say them to my loved one or me and because everyone deserves to hear such words. While some might shy away from the task of pronouncing death, the quiet moments with the dead allow me to reflect on the unceasing tragedy that is the Mediterranean. The quiet time allows me to comprehend that in every body bag a human tragedy lies before me, that a family somewhere has been irreparably changed, and that a person, not just a number, has left this world. The quiet one-on-one time reduces a mass tragedy to a personal level. This is often when the tears flow.
 
I’m so sorry, my friend. I’m sorry that I couldn’t stop this world from being such a horrendous place that you had to flee from your home and family and borrow huge amounts of money in an attempt to find a better life. You risked it all and lost. The people who sent you off in rough weather this morning in a massively overcrowded poorly constructed death trap of a rubber dinghy killed you. I find myself continuously enraged that there is no better place for your talents and dreams than the floor of the Mediterranean Sea. The fact that so many have profited financially from your struggle, and ultimate death, taps into deep seated anger that I don’t know what to do with.
 
Although we have participated in the rescue or transfer of over 4,000 people during my time on the boat, it feels impotent to sit on a small white and orange boat in the Mediterranean, going from disaster to near disaster, while people continue to drown. It is unimaginable that despite the tens of thousands of people rescued that the confirmed number of dead is virtually the same number of people as those who have been aboard Aquarius during my 4-month tenure. I wish we could do more. I know you can’t hear me, my friend, and I know it doesn’t help anyone but me to say it, but I’m so so sorry. I’m really trying and it’s just not enough.