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The Beginning or the End?


The beginning of third year clerkships is an exciting time for medical students. The first step of my licensing exam was finally behind me and I could now focus on applying that knowledge into a clinical context. I had heard many stories about the third year of medical school. Perhaps, what stood out most were the reflections shared with me when people witnessed death for the first time. From full codes to hospice patients, something about death seemed to draw out the most intense emotions and thoughts, which could change lives forever. Although I would always try to do the best for my patients, I knew it was inevitable that I would come across death. I wondered what profound thoughts and reflections I would have when I experienced it for the first time. It wasn’t too long before I was called to do CPR in the emergency department — and I found it did not play out as I expected.

I was walking by a patient room when a nurse saw me and asked if I wanted to “practice” CPR on a patient. It caught me off guard but I quickly learned to be confident and take opportunities like this because it may not present itself again. Before I knew it, I was applying compressions and it wasn’t long after that the doctor called the time of death. Before I even had a chance to remove my gloves, the doctor pulled me to the side to discuss differentials with me. I didn’t have time to process what happened — I was just shuffling from room to room the rest of my shift talking to other patients. Later, to my surprise, I wasn’t troubled by thoughts of the patient who had died in front of me — what concerned me was this lack thereof. Why did I not have the intense emotions and reflections that everyone has after witnessing something like that? Was I so jaded by the stresses of medical school that something like death could not even shake me?

I was plagued with these thoughts for months until I began my community-based education at the fire station. During this week, I had an experience that will stick with me for the rest of my life. The fire station was called because a man was attempting to commit suicide by jumping off a parking structure. I was not mentally prepared for what I saw when we got there. The man was seated on the edge, his legs still resting on top of the railing. His friends and coworkers were at the bottom, begging him not to do it. They told us about how he has three young kids, and a wife who needed him. I had run multiple codes during previous emergency department shifts, but it was never as chaotic as what I saw that day. People were screaming, crying and panicking. Security tried to get the situation under control, but it was like trying to put out a fire with glasses of water.

The man eventually swung his legs over the edge and at that moment, I lost my composure and began to cry a little. No one noticed because of how hectic it was, but that moment really got to me.  This man was about to end his life. He was in so much pain, that he saw death as the only option. How would his coworkers, friends, wife and kids be affected? It wasn’t like the death I saw in the emergency department. This time, I had the context of the man’s life, and I saw some of the people directly affected by it in front of me. I wanted to go catch him but I knew I couldn’t. Fortunately, an officer tackled him as he was thrusting forward, saving his life. When I went up with the paramedics to see him, his face was as white as a ghost. He wasn’t even able to move once the adrenaline left his system. I noticed he wrote notes on his arms to his wife and kids.

This man was a moment away from death, and now I was looking at him, safe, in good hands. I was overwhelmed with different emotions. I was happy to see he was alive, but sad that he was in so much pain that he was in this situation in the first place. I found out about how he was having trouble at work and that his wife was sick in the hospital. My heart ached for him.

I still think back to these experiences. I wasn’t jaded the first time I did CPR because I lacked context. A person had died in front of me, but I knew nothing about him. I reduced him to a medical problem. Unfortunately, I noticed that many of the staff did the same thing; but, I know it is not out of bad intentions. Sometimes it is easier to just think of the dead body as a medical problem than a human being. You need to move on quickly to your next patient, and I understand that. But after this experience, I promised myself I would never do that.

That man I did CPR on also had a story. Although I did not know about it, he deserved the same dignity as anyone else. I used to think of death as the conclusion to someone’s legacy. I now know that it is so much more than that. It isn’t just an end, but also a beginning. It is the beginning of a new chapter in so many people’s lives. The lives of the loved ones of someone who passed are forever changed. That alone deserves empathy and compassion. I’ve learned to give each human being the level of respect and dignity they deserve.

After my time at the fire station, I ended up doing CPR on another patient. This time I asked the resident if I could go with her to speak with the family. I will never underestimate the value of a life again. As a physician, I’ll always provide the best care possible for my patients, through life and death.

Image credit: Photograph by Stannate, used with permission under Creative Commons.

Omar Aldaas Omar Aldaas (1 Posts)

Contributing Writer

University of California, Riverside

I am currently a third year medical student at the University of California, Riverside. I plan on pursuing a residency in internal medicine.

  • Arum lily

    I can relate to your story. I am a medical student and at this stage we are supposed to take histories from patients and ‘master the art’ of history taking. I remember a young women was moved into the ward in acute pain suffering from UC. we questioned her mother and her husband regarding her illness and ended up knowing more than we were supposed to. She had married young and was a mother. She was the prettiest girl in the family, cheerful in nature and was known for her long thick hair. The women was shifted into the icu that day and we used to hear her scream from pain in the next couple of days. we later learnt she died after three weeks. I was shocked and it was hard to accept the reality. I began imagining how her family would have reacted and what would become of her little child. since then i began avoiding the icu because i knew it would be harder for me to process the death of a well acquainted patient and partly because i didnt want to become immune at all to accepting death and dying. your article encourages me to look for context of the patient as much as their medical history.