She was a woman in her early twenties accompanied by her husband. She was a first-time expecting mother at 19 weeks gestation with twins. They had received regular prenatal care and had been doing everything as the doctor had instructed to ensure a healthy pregnancy. She made this appointment because she felt something was off, her motherly instincts already keen. She and her husband had just gotten back from their ultrasound on the floor below, and they already knew the news that the doctor would give.
In a profession where we are trained to fight death around any corner, any day, students need to not only understand how to handle death in a medical setting but also how to cope with the weight we bring upon ourselves in end-of-life situations. No matter our past experiences, no matter our clinical training or how academically prepared we think we may be, it can be traumatic to feel the burden of responsibility for the loss of a life.
For me, one of these moments occurred during my neurology clerkship, a week into working in the Neuro Intensive Care Unit (NICU). I took part in a meeting with my team to update a family on the status of their loved one. It was my first time in this type of meeting, especially for a patient that I was directly involved in caring for. To our team of medical professionals, he is our 51-year-old male patient with a 45-pack-year smoking history but to his family, he’s a son, a husband and a father. All they understood about his condition up to this point was that Mr. R had a heart attack that led to some swelling in his brain.
so one day / i can translate to my patients / what my family missed.
Engaging strangers with kind eyes rather than tender faces, / Air hugs rather than warm embraces, / Family Zoom calls rather than face-to-face visits.
I actually don’t remember his name; he wasn’t my patient. I just saw him during rounds every day during my internal medicine clerkship. He was in his late-80s, and he was very ill. He had a long history of COPD, most likely attributed to his even longer history of smoking. He had been admitted to our service for a severe respiratory infection a few days prior to me starting the rotation. This was my last rotation of my 3rd year, and I walked in thinking I had seen enough COPD patients to know exactly what to expect.
You were my first patient on my first inpatient rotation as a third-year medical student, which meant that I had absolutely no idea what was going on. I was mostly concerned with trying not to faint during presentations on morning rounds. I stared at your bowl of Cheerios, the cereal beginning to turn the skim milk a pale yellow. Your brow furrowed in annoyance behind your thick glasses.
You call me on a Thursday to tell me / You were diagnosed with leukemia in October.
While the professor moved to the next slide, my face visibly blanched. All I could hear was the drowning sound of my own heartbeat thumping in my ears. Is this true? I thought. Nothing we can do? Only five years of survival? Did this apply to my grandpa Baba? But Baba has been sick for six years!
There were seven of us standing around the table as the attending surgeon debrided the infected fascia. The vascular surgeon came in the room and barked at us to identify the structures before us. “What’s that artery?” he interrogated us. “I’ll give you a hint,” he said, “there’s a deep and a superficial.” We named the sural nerve and iliotibialis band and the great saphenous vein. As we clamored around the table, I suddenly thought of the Rembrandt painting: The Anatomy Lesson of Dr. Nicolaes Tulp.
The incidence of chronic disease is strongly correlated with aging. According to the Information Theory of Aging, aging results from a progressive loss of genetic material due to gradually worsening cellular repair mechanisms. This cellular erosion leads to a nearly interminable list of diseases, including but certainly not limited to cancer, heart disease and neurodegenerative disease.
Allowing natural death gives the elderly and terminally ill the opportunity to control the end of their life, providing empowerment and a sense of peace during their time of uncertainty. This patient and her family’s forethought allowed us to provide medications to ease her pain and discomfort. When she closed her eyes for the last time, her body relaxed into the sheets, and I pulled the blanket up to her shoulders. Her family said goodbye, and then I began to perform post-mortem care.