Somehow I managed to complete a full year of clinical clerkships without bearing witness to a patient’s death. This seems like a marvelous and lucky thing, and it is for all the patients whose care I played a role in over the past year. However, this might not be such a great thing for me as a future clinician. Medicine is two parts science and one part humanity. The science part can be read in journals and learned from books, but the humanity part is learned by experience.
During rounds one day, an intern beckoned to me. He pulled me aside and asked if I had ever seen a physician declare a patient deceased. I told him I hadn’t, and we took off to a different floor. He told me that it was one of the interns’ duties to “declare” patients and that they regularly got calls to do so. I got the impression that we had to go fast. We needed to get this done and get back to rounds.
All I knew as we climbed the stairs to the patient’s room was that the patient was someone neither I nor the resident had ever seen before, a woman, and had been very sick. When we arrived at the room, a male nurse tech was outside crying softly to himself. The door was closed. The resident took a moment to compose himself before we entered.
There was no family inside, so the resident was able to take the time to teach me exactly what he had to do and why he had to do it. We felt for radial pulses, tried to auscultate a heartbeat in the chest, palpated the carotids, did a sternal rub and checked for a corneal reflex. There was nothing. The patient was declared dead at 10:10 a.m. on a Wednesday morning.
The nurse took us to the waiting area so the resident could inform the family. As soon as the nurse introduced the resident, the patient’s relative — a woman around the same age as the patient — started sobbing and shaking. The resident told her that her relative had passed away.
The nurse tried to provide some comfort and offered to call someone. The resident just sat there, ineffectually offering, “Is there anything I can do?” over and over again, while I stood quietly and awkwardly in the doorway doing nothing at all. After several intense moments, the relative asked through her tears if she could sit with the now officially deceased patient. The resident told her to take as much time as she needed, and then we left.
The relative sobbed down the hallway, alone and uncomforted.
That was it. We didn’t even bother to find out who the patient was to this woman. Her sister? Her mother?
There was no hand-holding, no consoling, no walking her back to the room, no tissues, no “do you have any questions,” no nothing. There was only stone-cold truth and efficiency. The whole interaction was over in less than three minutes. The resident signed the death certificate, and we went right back to rounding.
To my own embarrassment, I was just as cold to the patient’s relative as the resident. Worse maybe, because all I could think as that family member was hysterically crying, walking down that hallway all by herself, was how wrong it was and how I should go to her. But I didn’t. I left when the resident left.
The resident broke no rules and violated no policies. He did his job — no more, no less. But can’t we do better than that? Isn’t there a higher level of dignity for us to strive for? Didn’t that distraught family member deserve a little of our time and consideration?
We can do better. No matter what, every patient deserves dignity, time and consideration. We must remember that our patients and their families are human beings. Death might be inescapable, but it’s our job to make sure empathy, kindness and grace are inescapable as well.