As future physicians, our goal is to learn how to prolong life. But we ultimately lose. We’re not naive to this fact, but we try to avoid it – not only the event but the discussion.
How do we as medical students approach death? What’s our role in the care of terminal patients?
In this post, I reflect on my experiences and thoughts on dealing with mortality. I’m no expert. But then again no one truly is.
I’ve had my encounters with death in medical school. I’ve cared for patients with only months, days, or no warning at all. Some were sent home – others not as fortunate.
Even with repeated exposures, the experience is paralyzing. I’m reminded, with each passing patient, that my efforts at best are temporary wins. Death comes for everyone. Each patient lost is a cruel reminder of my limits as a provider.
Dealing with death in medical school is hard. We don’t face it enough to grasp it. Perhaps we never will. But what’s our role? How should we talk to a dying patient? How should we approach their care? What can we do for them in their last hours or days?
My First Death In Medical School:
It was during my internal medicine rotation. I checked the patient list to count how many patients our team would be admitting that day. But the board was baffling. Where was our sickest patient?
I turned to the senior resident and asked where patient 540 was? Did he get transferred? Did the liver attending decide to send him home? The resident looked at me, unfazed, and said, “Oh, he passed away last night.”.
I felt frozen in place. Didn’t know what to think. I had just seen this patient less than 12 hours ago with my attending. The family was asking what his next treatment options were. Little did he know he was already facing his last hours.
You will never forget the first time you hear that a patient has died.
My First Code In Medical School:
I stepped out the elevator after seeing my patients in the morning. I see my fellow med students and the intern running towards me. They pass me and yell the room number. The room number belonged to a young female with pancreatic cancer. This same patient had learned yesterday our disease was terminal.
Now today I was watching what true chest compressions were. It was odd watching how the so-called robust ribcage compressed like a balloon with each push. The body didn’t look real. It appeared lifeless.
I felt myself clinging on for some miracle during each pulse check. “No pulse” was all I heard each time. I felt powerless just like that rib cage.
Regardless of all the patients we had saved prior; we failed this one. At that moment, the previous victories were no consolation for this enormous loss. Death again was the victor.
My First Terminal Patients in Medical School:
If my internal medicine rotation taught me anything, it was the aspect of being a humane doctor. When we treat heart failure or pneumonia, we can get away treating the symptoms and not the patient.
That same luxury doesn’t exist for patients on their death bed. I was fortunate to learn how to practice this delicate style of medicine.
The first was a 60-year-old man with late-stage liver cancer. By the time I had admitted him, he was ready to face death. He became sicker from the treatment he was receiving than the actual disease we were treating.
It showed on his body. Every element of his internal anatomy was vivid. The separations of his muscles, or whatever was left, was shockingly evident. This was a man with few days left. He decided to pursue hospice care.
He was not a patient who required me to listen to his heart or lungs. More than any patient, he deserved that I listen to him.
I asked about his life, his family, and his hobbies. He answered -when he could muster the energy. But it was clear he wasn’t ready to die. He desired more time with his daughters and grandkids.
I again felt as helpless as the rib cage during compressions.
During this time I was reading Atul Gawande’s Being Mortal. (Every medical student should read this) It’s essential to understand mortality from the side of the patient. Dr. Gawande beautifully captures these experiences.
I knew there was little I could do for this patient to prolong his life. But the book helped define my role as the medical student. My purpose was more than just reporting his pain level and symptoms back to the team. I could make his last days more comfortable.
For example, the team and I learned how much he enjoyed drinking mineral water. He named a specific brand, and we surprised him with a few bottles. He whispered thank you. I asked him if he wanted to drink it now. He replied he’ll wait to share them with his family.
That answer will always stick me. I’d like to think we provided a grieving family with an opportunity to spend time together enjoying something he loved.
I have many more experiences. Each one of us will have countless events regarding mortality that stick with us. Focussing on the lessons from each encounter is essential.
No, we can’t save every patient, but we can provide them with a source of comfort, an ear to listen, and a hand to hold. I’d argue that’s something.
As a medical student, we have the privilege to care for sick patients. We’re reminded by these patients how vital personalized medicine and interactions are.
Remember to show you care. Think about ways to make their stay more comfortable. Talk to their families and provide comfort and support whenever possible.
Create laughter whenever appropriate. Respect silence when it’s desired. Become malleable to any emotion.
I like to think that when our patients are on the cusp of death, we are no longer medical students. Instead, we are a fellow human who can provide our presence. Our goal is now to enhance the quality of the days left.
Death never becomes easy, but taking care of these patients can be the most impactful thing we do in medicine. Never forget that it’s not always about winning or losing. In this case, every day we are attempting to win the battles and less concerned with the war.
Hope you enjoyed my experiences with death in medical school. I hope you can carry with you similar experiences to shape how you approach these situations. Please comment below or message me on experiences you’ve had and how you’ve handled them.
If there is something specific you’d like me to address in a future blog post, comment below or email me at [email protected].
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Until next time…