We met as a team in the back hallway every morning to review cases for the day: a 4-month-old male with retinal hemorrhages and posterior rib fractures, a 35-year-old female found unconscious next to an empty bottle of painkillers, and a 42-year-old male who fell at work. At 8 a.m., they were strangers to me, but over the next few hours, I would become more intricately familiar with them than I had been with any other patients who I had ever encountered. While I knew little about these people at the beginning of the day, I always started out knowing one very important fact: they were already dead.
As medical professionals, we are generally assigned the task of saving lives, but what about the other side, when the life can no longer be saved? I faced this challenge daily during my rotation with the medical examiner. It was a different view of medicine and uncharted territory for me as a student. We are trained to be acutely aware of death in the medical field; it is our constant, lurking enemy. Behind the diagnostic criteria, labs, imaging and follow-up appointments, we keep in the back of our minds the goal of delaying, as long as possible, this thing called death.
Anatomy lab gave me a glimpse into this morbid world with an initial exploration of the human body, a privilege provided to students by the sacrifice of donors. Brushing up on my anatomy skills was one of the main factors that drove me to choose the medical examiner rotation as an elective. I thought I was prepared for what I would see because of my previous experiences.
But how could I prepare to see a 4-month-old victim of child abuse lying cold on a table: a sweet infant who experienced horrific evil?
It was my first day, and as I watched the pathologist begin the dissection, I thought to myself how unnatural the body looked. A baby should not be cut open. His organs should not be removed from his body. His eyes should not be viewed under a microscope for evidence of violent shaking, and his brain should not be evaluated for traumatic bleeding. I should not be able to reach my hand through his now empty abdomen and feel his posterior ribs for signs of healing fractures. He should be laughing, trying to sit up on his own or starting to eat infant cereal. He should be crying, and he should be free to do so without fear. He should be held, loved and cherished, but he was not.
Those thoughts were racing through my mind when, halfway through the autopsy, the pathologist looked up at me and said, “This case will keep me awake tonight. We cannot do anything to save him now, but we will do everything we can to get justice for him.”
These words sparked a change in me. They indicated that ceasing to feel was not a requirement. I was uncomfortable seeing an infant separated into various parts because I should be; it looked unnatural because it was, and this work was done because it must be done. It matters. The point was not to grow numb to humanity or find words to justify the unthinkable. I realized the point for me was to remain uncomfortable and allow that discomfort to fuel my passion.
I carried this thought with me for the rest of the rotation and even now. I let myself feel for the 35-year old female found next to an empty bottle of painkillers and to wonder why her toenails were so freshly painted only days before she committed suicide. The 42-year-old who fell at work had fallen off of a roof and died at 8:30 a.m. This means that I probably woke up at the same time this man did. In the same city, we both ate a quick breakfast, put on our shoes and went out the door feeling nothing particularly unusual. He never could have known, and neither could I that, later in the afternoon, a PA student and a medical student would be elbows deep inside his abdomen.
I let myself imagine him the day before not knowing it was his last. Every weekend I thought to myself that the people we will do autopsies on this week are probably alive right now. They did not know they would soon be in an autopsy suite with undigested food in their stomachs as evidence that they had anticipated staying alive. They were fueling themselves for the future not knowing that they would no longer have one on this earth.
I was alarmed to see a person’s lungs pulled out and lying on a table because that was not where they belonged. I recalled seeing a kidney sitting on a person’s leg, and I was bothered. That’s not where the kidney goes, I thought. These views may sound morbid and disturbing, and that is because they are. This, I decided, was the most important fact of all.
The moment when I find myself unmoved is the moment when I have lost part of what drove me to pursue medicine. Human life should continue to matter for me to be an effective and passionate provider in the future, and that requires facing and absorbing the realities of death.
Throughout the five weeks, I maintained as much feeling as I could, and it continues to drive me even today. I think about those humans often. When I see a 4-month-old baby in his mother’s arms, I rejoice at the comfort that he is allowed to experience in his fragile state. I respect the endurance of moms and dads who push through the frustration of parenthood. I take the man or woman with suicidal ideation seriously having seen people who followed through on these horrific thoughts. I let myself reflect deeply on the unpredictable nature of our existence: the transience of human life. I have a responsibility to not only assess and treat, but also to value each human with whom I come in contact.
I entered this field with the goal of improving and promoting life, but that is not always within my control. I am certain to witness healing and survival, but I must also expect to see pain, suffering and loss. These experiences should not be avoided or diminished for my own ease. I will need to find ways to cope, but coping cannot mean disconnecting entirely. Allowing myself to continue to feel the pain of my patients and their families should not immobilize me into inefficiency.
Instead, it should provide meaning to every seemingly insignificant piece of information that I learn from a textbook. It should drive my desire to listen more closely and think more critically; it should cause me to pause and question myself when I am uncertain. At times, what I witness will be so difficult that it deserves a sleepless night. If caring for my patients means that I will have to experience discomfort and pain myself, then I am choosing now to humbly and graciously welcome that role.
Image credit: Reflection by George Tsilepidis licensed under CC BY-NC-ND 2.0.
Physician Assistant Student Guest Writer
Eastern Virginia Medical School
Ashley Luebbers is a physician assistant student at Eastern Virginia Medical School in Norfolk, VA. In 2011, she graduated from James Madison University with a Bachelor of Science in dietetics, and she obtained a Master of Science in nutrition and dietetics from Central Michigan University in 2016. In her free time, she enjoys traveling with friends and reading C.S. Lewis novels. After graduating in May 2019, Ashley plans to work in emergency medicine with a focus in pediatrics.