Although there is really never a right time to die or even witness death, it is important to acknowledge that death is a reality, and one to which all health care practitioners will be subjected at some point in time. For that reason, I raise the question: is there an appropriate time to lose a patient? From my perspective the answer is yes, and for good reason.
Having recently finished 12 weeks of internal medicine, the first of my core third-year rotations, I vividly remember the excitement I felt when walking into the hospital. I knew all the work I accomplished in the classroom was about to be put to good use. I had the opportunity to help interns, residents and attendings to positively impact individuals’ lives. I would see patients with diseases that I had previously only encountered in textbooks, although I knew that these textbooks rarely highlight and explain the pain and suffering that accompany these pathologies.
In fact, my studies to that point had left me with some naiveté, which I must assume all medical students experience when first starting clinical work. We are excited to see cases we read about, although we often forget that many of these ailments take the lives of those afflicted. Throughout our education, we transform conditions into hypothetical situations, rarely developing an understanding of their severity. It is easy to regard a set of symptoms as fiction or case study, and it was only through experience that I discovered that we must not be so quick to desensitize ourselves to these cases and the people affected by them.
I was challenged with observing the death of a patient early on in my rotation. Three days before her status began to decline, we had a long conversation about her children, the upcoming holidays, and her plans upon discharge from the hospital. At this time she was in relatively good shape, and to me, she was just another case study. Over the course of the following days, she took a turn for the worse. Morning rounds started to focus on end-of-life care, and a do not resuscitate order was put in place. I began to realize how shameful my earlier mindset had been as I stood on the sidelines in disbelief. A patient with whom I had laughed with just three days previously was now facing impending death, and I was faced with the challenge processing this reality.
Losing a loved one is painful and significant, but witnessing a patient’s death is different. I had seen death before, having lost family members, but had never experienced the sense of responsibility that comes with being a part of the care team. We are trained to understand death as an inevitable outcome for many diseases but we often fail to learn and understand how this process impacts our patients, and how family members will feel during this time. In talking with colleagues, the overwhelming consensus was that witnessing the death of a patient is an experience never forgotten. Many agreed that it shaped them into the physicians they are today, and impacted how they treated future patients.
In reflecting back, I believe that it is important to leave time to assess a patient’s understanding of their situation. Instead of focusing on outcome, we can talk to patients about what will make them feel most comfortable during these times. I feel lucky that the patient who taught me about the end of life was a sweet and caring individual. In reality, she appeared to accept her own death more easily than I did. I will never forget the impact she had on my life and career, and I would like to believe our laughter and story swapping may have eased her mind to allow for a more comfortable hospital stay in her last few days.
Most importantly, this patient shaped the way I approach all of my patients, just as my colleagues predicted. It is easy for students, residents and attendings alike to lose sight of the individual’s emotional well-being in the hospital setting. We are responsible for so many patients and we quickly forget that each patient is a separate entity that requires the same attention and care. Having experienced loss so early on in my career, I will never forget the lessons I learned through this loss, and I do believe they will make me a better physician, one who is more capable of caring for the whole person. For that reason, I believe there is a right time to lose a patient. To the patient I will never forget I want to say something I never got a chance: thank you.
Photo credit: Photograph by Nishanth Jois.