Thoughts About Death and Residency

10/11/2003 15:19:36
tags: medicine

It’s interesting to look back on how my perspective about and attitude towards death have changed throughout my experience with medicine. I still remember the first patient I had contact with who died as if it happened yesterday. Since then I have worked with many more patients who have died (working in the ER does that) and have even given a few lectures about it.

The first experience I had was when I was working as an EMT. We were going to transport a patient from one ER to another. The patient was a young child who was in critical condition. Upon our arrival, the patient had arrested and CPR was being performed. It was hard on everyone, including the doctor in the ER. I remember how no one wanted to give up, even though we all knew that it was over. I remember how the doctor was asking everyone, myself included, if we had any ideas for something else to try. Of course, we did not. Everything had been done. But nobody wanted to “lose”, especially when it involved a child.

Throughout medical school and my residency thus far, I have experienced working with other patients who have died. And strangely, they (and their families) are some of the patients I remember the most about. Most of these deaths did not come as a surprise - some diseases can not be cured. Perhaps knowing this allowed better communication about an issue that is difficult to talk about.

One patient who stands out in my memory was a patient that I never really got to speak with. He was basically in a coma when I first began to care for him, and aside for responding briefly, though incoherently, to neurological testing, he never woke up. His prognosis fluctuated, and over time it became clear that he was probably going to die within a matter of days to weeks. I never got to speak with him, but I got to know a little about him through his family. I had a closer relationship with his family than with the family of any other patient I have treated thus far. I couldn’t save their loved one, but I could help them. I made extra time in my day to speak with them and to make sure that they were up to date on what was happening. I got to know them fairly well, and they began to trust me, even though I was only one of the team of doctors taking care of their loved one, and I was not the most senior of the team.

The patient died on my day off. By the time I got in the next day, his room was occupied by someone else. I didn’t get to talk to his family about what had happened or how they were doing with it. His death was not unexpected, but that doesn’t make things any easier. I still wonder what it was like for them when he died, and I am sorry I was not there to help them.

I learned a great deal about intensive care from this patient. Perhaps that knowledge will contribute to helping someone whose life can be saved. But more importantly, I learned about how to relate to the family of someone who is dying. I couldn’t save my patient, but I really hope that I was able to help make his death a little less frightening and confusing for his loved ones. And that is something that I know will help to make me a better doctor, and hopefully a better person, in the future.

As I compare these, and other, experiences with death, I realize how complicated it is. It’s easy to isolate yourself from the emotions. It’s easy to forget about the person behind the disease. You quickly learn that it is the patient with the problem (to paraphrase Samuel Shem’s House of God), and that you have to separate your pain from their pain. But it’s hard to let go of part of those defenses and really share in the sorrow that is going on all the time in a hospital. I think we all get better at it, but no one perfects it.

I guess this issue has come up because I have heard a great many stories about other residents and doctors who have died recently. I haven’t known any of them well, but I have friends who were personally affected by their deaths. It seems different when somebody dies who was “one of us.” It really finds a way to sneak past your defenses and make you question your previous stance on all of this. Maybe that’s a good thing, as I think that the real key is not to become too “comfortable” with death.

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