The Journey from Life to Death

Vinh Tran is a Canberra-born Vietnamese-Australian, currently working as an Intensive Care registrar at Canberra Hospital in Australia.

Image: © Dušica Milutinović, 2022

I’d like to share a case that I was involved in 3 months ago that made me reflect on my views on life and death and how my cross-cultural background has informed those.

There was a middle-aged Vietnamese gentleman admitted to ICU. Unfortunately, due to multiple events, he developed hypoxic brain injury. Now, the thing with brain injury is that the first 5 days are crucial, as they generally predict how well a patient will recover. This gentleman ended up staying in the Intensive Care Unit (ICU) for 3 weeks as we continued to monitor his progress in hopes that he would make some kind of recovery.

During the first week of me taking care of him, I introduced myself to his parents and gave them an update on his progress. I’ve updated many families regarding the progress of their loved ones, but this interaction was quite different. Instead of feeling like a doctor speaking to a patient’s family, it felt more like a nephew speaking to his uncle. That night I went home and I asked myself why was this the case; what made it so different? Yes, one aspect was that I was able to speak Vietnamese and so I was able to bridge that communication barrier, but there was more…

Eventually, I realised it also had to do with our beliefs and our culture’s perspective on life. There was one line he said to me in Vietnamese that hit me quite hard, he said: “mỗi người có một con số trong đời”, which means: “everyone has a certain fate in life”.

In Vietnamese culture, we often believe that everyone has their own unique path in life, and – yes – our actions contribute to the direction we follow in life, but at the end of the day, fate plays a very large role. I remember my parents using that same line as I was growing up, especially when I was applying to medical school. I failed for so many years, and there were times I wanted to give up because I was so tired. I would ask my parents if I was ever meant to be a doctor or if I should move on and find another career. My parents would use that line to keep me calm and focussed. I must admit, when they told me that line while I was frustrated, I didn’t absorb it well. But as I calmed down, I reflected on it and deep down inside of me there was this flame that kept staying ignited despite my failures. It was at those points that I felt it was my fate to be a doctor and so I kept persisting for a total of 4 years. Looking back on my failures, they were probably some of the best things to happen to me because I learnt to persevere and accept failure as a part of life. Overall, I guess my culture has certain phrases to help us accept unexplained, difficult events in life.

As the days went by, the patient eventually opened his eyes spontaneously and could breathe on his own. Unfortunately, he didn’t respond to any auditory, visual or physical stimuli. What this meant was that the upper region of his brain, which is responsible for processing information from the outside world, was damaged, and this was confirmed on an MRI brain scan. One of the hardest moments in my life as a doctor then arrived. My consultant and I organised a family meeting to discuss the patient’s situation and the management plan. My role was to translate the information into Vietnamese, and to ensure both sides understood each other’s thoughts and wishes.

After explaining the patient’s situation, the family, especially the parents, were surprisingly accepting of the situation. But they asked one question that was extremely difficult to answer. The question wasn’t complex, but simply because the answer to that question would change their lives forever. They asked, “Will our son ever recover?” I knew the answer to it, but after a brief discussion with the consultant, I told them that due to the brain injury he had sustained and our daily assessment, it was highly unlikely he would ever recover to his original state. There was silence in the room as the family processed the information and slowly accepted that this was their son’s fate.

So, what happened to the patient? He was extubated two days later and he passed away surrounded by his loved ones. A week after the patient passed away, I asked myself, “What does end-of-life care mean to me?” This question impacted me because I’m Vietnamese yet I’m a health professional in a Western society. From a Western perspective, my view on end-of-life care is comprised of three things: 1) patients should not be in any physical or mental pain; 2) they should be surrounded by loved ones; and 3) they deserve to be in a private, respectful environment. From an Eastern perspective, being raised by first-generation Vietnamese parents, I share the same understanding as the patient’s family, in that I really do believe everyone has a certain fate in life that we cannot control at times.

At the end of the day, I believe both cultures share a similar understanding that death will always be a part of life. However, from a Vietnamese perspective, I feel that our culture accepts death as a large aspect of life, which is reflected in the Vietnamese quote I explained before. In Western culture, yes – death is an accepted part of life, but we also hold onto hope for miracles. As a Vietnamese-Australian doctor in a Western society, I am constantly having to battle between accepting death as a part of life and hoping that miracles will happen. At the end of the day, all I can do is the best for my patients and their families.

Overall, what did this whole experience teach me? The connection that I have with my patients is not simply the fact that I’m a doctor and they are my patients – it is much much deeper. Instead, it’s about the language we use to communicate with each other, the differences or similarities in our beliefs about life, and the way we work together to understand and compromise for each other to reach a common goal regarding life and death.

© Vinh Tran, 2022