what death looks like here

"Public health is the art and science of deciding who dies,

when, and with what degree of misery." - Bill Bicknell

Swaziland, December 2005
she'd been sick for a while, sent home from the government hospital because they had nothing left to offer her. HIV and t.b. combined forces to drain the life from her body. she spent her final days at her homestead, with her momma, sister, and baby boy at her side. her last night on earth was spent singing and praying. she offered up prayers of forgiveness - for the one who gave her the virus that took her life and the life of their firstborn child. my friend tells me she was at peace and that was why she could die that day. she was 27.

United States, May 2011
he'd been sick for a while. cancer and age and recurrent infections numbered his days. he spent his final days at a long-term care facility, his life sustained by machines. his heart stopped on three occasion during his last night on earth. two of those times it was forced to beat again with the help of electricity and chest compressions and chemicals pumped into his veins; ultimately, his 80-year-old heart refused to beat any longer. 

one of these deaths was inevitable. one was preventable. one called on every bit of science and technology available; the other called out to the heavens. one was alone in an ICU bed, with doctors violently attempting to bring him back to life. the other was surrounded by friends and filled with peace and acceptance. 

i know that you can't put a cost on a human life. i know we don't get to decide who lives and who dies. but i struggle with how we can spend millions of dollars to extend a life by months while not spending the hundreds of dollars that would extend a life for decades. i hate how being born on the wrong side of the equator with the wrong color skin means your life might be thirty years too short. i hate the days i go to work and order tests and medicines that will only sustain a person with a terminal condition for a few extra days. i hate that my inbox fills with messages from swazi friends who can't get to doctors or can't afford medicines for things that are treatable. i hate living between these two worlds, of seeing the injustice and disparity. i hate the powerlessness - both in futily treating terminal conditions in order to honor a patient's wishes and in being unable to treat curable conditions in those without choices or options.