Joanna Cannon on What the Emergency Department Taught Her About Death

Doctor-turned-novelist Joanna Cannon says the real lessons about death came not from five years of medical school but from her first shift as a junior doctor in August 2010 — when, twenty minutes in, her bleep went off with the instruction: "Could you come to Ward Seven and certify a death?"

In a personal essay published alongside the release of her book An Unlikely Visitor (Scribner), Cannon describes how medical school taught her every way a body can fail — through lecture theatres, crash-call workshops with "fake patients" and suturing practice on oranges — yet, as she puts it, "we didn't really learn about death until after graduation."

That first certification stayed with her. The patient was an elderly woman whose death was quiet and expected, but who gripped the bedclothes "as though she had tried to hold onto the world." Beside the bed lay a paperback with a bookmark deep in its pages. "Now she'll never know how the story ends," Cannon writes of her reaction.

What did Cannon take from these moments?

She began collecting what she calls her "Kodak Moments" — small, unresolved images of patients and their families. They include Elsie, an elderly woman wheeled into resus after a cardiac arrest on a stormy night. Elsie's husband waited in the corridor; when Cannon passed him after time of death was called, he was holding Elsie's navy blue raincoat, "creased and wet from the storm, and waiting to be worn."

Another involved Elizabeth, a 35-year-old admitted with a racing pulse, chest tightness and what doctors call a sense of impending doom. Because of her age, her symptoms were attributed to "just anxiety" — Cannon notes the habit of putting "just" in front of any mental health condition. Within five minutes of two medical students following her into a cubicle, Elizabeth went into cardiac arrest. A consultant cardiologist happened to be in the next cubicle; a resus team revived her within minutes, and she was transferred to the Coronary Care Unit. The cardiologist's verdict: "well she was right about the impending doom."

Cannon wanted to ask him what it felt like "to argue with God," but kept quiet. A doctor's job, she had already learned, is histories, X-rays and cannulas — not talking about feelings.

What does this change for how we see medical training?

Cannon's argument is that death's meaning lies "in bookmarks and raincoats, not in textbooks and lecture theatres." Fluency in anatomy, physiology and pharmacology, she writes, isn't enough: "you will only become a good doctor when you recognize that sometimes the very best thing you can do for a dying patient is to stop trying to fix everything, and just sit and listen." Her closing line is blunt: "There are some things which cannot be taught."

Ten years after leaving the wards, she says she still carries these moments like small post-it notes — a legacy of patients who bring her comfort and perspective when her own problems overwhelm her. Readers can judge how the experience shaped her fiction: An Unlikely Visitor by Joanna Cannon is available now from Scribner.