He is younger than me! This is not happening. This could have been me.
These are the thoughts running through my mind when I witness my first patient death. I’ve seen a few other deaths in my medical career so far, but I will never forget the first time I saw someone die. I know the patient from before his hospital course. He was hit by a speeding car while biking home. He’s few years younger than I am, still in high school, while I’m in med school. I even know the street where the accident happened. It all seems so eerie and unnerving. The trauma he suffered was so devastating: he bled into his brain, and by the time we saw him in the hospital there was nothing to do.
The worst part is breaking the news to his family. I go with my attending to talk to them. I don’t speak, but still it feels like a cold stone is cutting through my heart. All their dreams, hopes, aspirations for his life just evaporated. In one second they were working on college applications, the next they are thinking about funeral arrangement and burying him. We are all too human after all. We have emotions; we empathize and feel the pain of others. My attending reminds me of that while we walk away from the grieving family. He encourages me to sit down with him to talk after we finish our duties. I feel reluctant to talk to him, because I don’t even recognize what feelings I am experiencing. This is all too disconcerting! A young man just died, and we could do nothing to help him. Years of medical training and education became useless to intervene and save his life. I’ve seen so many patients get better and appreciate what medicine has to offer. But then again, isn’t my patient dead? What if this was me? Or even worse, what if this was a loved one? Could I or my team have offered anything to help?
At the end of a very busy day when my resident dismisses me, I think my attending has forgotten what he told me in the morning. However, he—my attending—is adamant that we talk about something I don’t feel comfortable talking about. He wants to talk to me about how to handle the death of my patient, and I don’t want to. All I want to do is forget the feeling of helplessness and focus on what I can do to help everyone else.
We sit down, and I sip on the cup of coffee in my hand. My attending isn’t that much older than I am, maybe ten years or even less. He jumps directly to the point and starts talking about the events of the day. He asks me how I feel about my patient passing away. I can’t really respond to the question, because I don’t have a expressible answer, just a gut-wrenching sensation in my belly. Was someone to blame here? No, not really. There is nothing that could have been done to change the course of events. So I take another sip of my now cold coffee and reply vaguely: I feel okay. Nothing to say.
He starts to talk to me. “I don’t really remember the first time I saw someone die. I was young, and I saw people dying even before med school,” he said. I forgot that he was in the Army for few years before his medical school training. I think to myself, war is different than patient care. You expect people to die in war; you know people die in hospitals too, but you never want to be the one with the dying patient. He saw my distant gaze and continued, “But I know how if feels when you suddenly realize that you’re hopeless. You wanted to help but you can do absolutely nothing. I have felt it, and I know exactly what it feels like.”
I’m surprised now; what is happening here? Is he going to talk to me about a war story? How is that relevant here? He continues talking: “I never forget when I felt utterly helpless. I had a young patient who was just about to get married. She came in with the worst case of full blown AIDS you can imagine. Her immunity was basically non-existent, and she was septic. As we diagnosed her, she went into full shock. Psychologically and physically. Her blood pressure was crashing no matter how many fluids and pressors we used. She started sobbing. She started to hysterically shout at her mom. In between the sobs, we learned what was going on: her uncle had raped her. She was never with a man; she was just a child! We tried our best to get her out of that shock at least circulation-wise. Her heart beat stopped. I took a step back and watched the nurses and the ICU team start the compressions and the code.”
He pauses and takes a quick sip out of his coffee. “We couldn’t save her that day. I forgot about it for months. But you know what? People always talk about PTSD as if it’s only a thing soldiers experience. I think what hit me months later was the PTSD flashbacks they talk about. I just suddenly remembered all the details of that day while driving home from the hospital many months later. It was an intense emotional reaction. You remember the smell, the noise of the ICU, her pale face as she lay lifeless on the bed, surrounded by strangers and machines. You forget about most patients, or have a hazy memory of how they passed away. The more peacefully they pass away, the easier it is for you. But this was nothing like that. This felt like a flood of intense trauma with vivid recollection.”
I start to think about how he reacted to what he had gone through, wondering if any of that had consequences on his career or personal life. I don’t know what to add to our talk so I simply ask, “How did you handle it?” He gives me a hint of a smile and says, “I was lucky. I had the greatest, most understanding fiancé I could ask for. We need support. We all think that we as doctors are miracle workers, believing that we defy nature and overestimate our medical powers. We are all too human. We need to have a social support, whether it’s a loved one, friend, family member, or even a professional. We need to let it out and talk about it. Death is the only certainty in life, and unless we can handle it, we will have a hard time handling life itself.”
I thank him and walk away muttering to myself: unless you can handle death, you can’t handle life itself.