(At the request of a few readers, I’m reposting this Question/Answer from earlier today, to allow for easier reblogging. Thanks for all the positive feedback and comments.)
Anonymous asked: Hello doctor!
Have you had anyone die during your practice, in your hands? I’m guessing no? But I hear it’s rather traumatic (for non-medics, anyway). My mom held her mom in her hands while she passed away some thirty-five years ago and still hasn’t gotten over it. How do doctors handle the “angel of death” hanging around hospitals? Do they touch on this in med school? I work in a hospice home, hence the questions!
Greetings, Grimy Reaper —
No, I haven’t had anyone die during my practice working in urgent care — but I’ve witnessed plenty of deaths first-hand in medical school and residency (the slowly-evolving expected deaths, as well as the sudden traumatic “SURPRISE!” deaths). I doubt any medical student will get through their entire educational experience without witnessing at least one death — and most will even be involved in situations where, despite (or because of!?) their efforts, someone will die anyways.
I would dare to say that being involved or present with a death, no matter how expected or traumatic or peaceful or inevitable it may be, is always traumatic, to everyone, medic or non…. but the way in which that trauma is felt and interpreted and displayed is a very individual thing, and will change over time as a person is exposed to more and more faces of death.
Any medical school worth its tuition will provide some clear and honest education on “living through a patient’s death experience” before a medical student goes anywhere near patients. But no matter how much tips and anecdotes are bantered around in a classroom, every student must discover for himself how his first “Death in the Room” experience will affect him (or her). I know that I wasn’t truly prepared for the reactions that I felt during the first witnessed death of a patient.
(I don’t know if you intended to get an actual story out of this question, but here you go) — During a rotation for internal medicine, a 50-something woman with metastatic breast cancer was admitted to our ICU, with cancerous fluid building up in her pleural space (around her lungs). She’d been dealing with this effect of the cancer for many months now, and it was “routine” for her to spend a night in the hospital when the fluid would get too much for her to deal with — she’d get the fluid drained out (pleurocentesis: sticking a needle into the chest and letting the bad juice out), then go home the next day feeling much better. Despite the breast cancer’s spread, she was actually doing quite well, looked healthy, had good energy.
She was actually the first person that I’d ever assisted on for a pleurocentesis, and it went very smoothly. My senior resident and I finished her “tap” by 9pm or so, she went to bed, her husband left for the evening to get some sleep at his home a few miles away.
Around 4 am, my “code blue” pager went off — ICU, Room 4! I ran into the ICU, heading for my lung-lady’s room before I realized, “Wait a minute — she was in Room 5. Room 4 is a different patient entirely!” Turned out that Room 4 had a patient “belonging” to another medical service, a 90+ woman with end-stage COPD and congestive heart failure, whom I had never met before. I got to know her, or at least her body, quite quickly, because her heart had jumped the rails, and I was up on her bed doing CPR chest compressions in a flash. As I and the ICU nursing staff worked on getting her heart going again, I got someone to tell me her story, and it wasn’t good. She had already “coded” 3 times in the past week or so, and for some bizarre reason her family refused to just let her pass away, even though she couldn’t survive off the ventilator and her heart was (obviously) getting worse day by day — so a “full code” was still expected. I could feel her already-broken ribs flopping around under my hands as I pumped her heart for her. Her chest was a mass of multi-colored bruises from the prior codes that had been run on her in the past few days. I felt like I was assaulting my grandmother, and for what? I yelled for someone to get her primary doctor or her family on the phone, so we could stop this ridiculous farce and let this poor woman finally get some peace.
We coded the woman in Room 4 for 15 minutes or so, and her heart never regained a rhythm, finally slipping into asystole. With her doctor on the phone with me, I “called” the code and we stopped our interventions. The respiratory therapist began preparing to extubate her, and the head nurse left to call her family… but since the heart monitor alarms had been muted, nobody remembered to disconnect her cardiac leads.
I stepped out of Room 4 to be met by another ICU nurse. She looked at me sadly and said, “Your patient died.” I was confused and bemused by her rather-obvious statement, and said, “Yep, finally.” It was the nurse’s turn to be confused, as she pointed at Room 5 and said, “No, I mean, the woman with the breast cancer. She just died while you were in Room 4 running that code. She was a no-code (Do Not Resuscitate orders were in her chart), so we didn’t interrupt you with the news. But you should probably call the husband and let him know.”
I was floored. Room 5? The lady who had smiled throughout her pleurocentesis and kissed her husband good-night before he left? Room 5? Dead?
As I stood there, mouth gaping at the bizarre coincidence of TWO patients dying, in adjacent rooms, within minutes of each other, the respiratory therapist called to me from Room 4 — “Hey, this woman’s heart is beating again! Look at the monitor!” Sure enough: that frail and bruised old lady’s heart had decided to resume a regular sinus rhythm, after at least 3 minutes of un-supported asystole. (She eventually, FINALLY, died in her sleep 2 days later, and I was so glad to hear that news. I never met her family, but I cursed them for their ignorant decision to prolong her suffering.)
This was the last straw: Room 5, ought to be alive this morning, dead. Room 4, was dead this morning (again), and now alive. To perfectly cap this emotional whiplash of a morning, I turned to go use the nurse’s desk phone to call Room 5’s husband — and he walked into the ICU, carrying breakfast for his wife.
My mind went numb. I watched myself walk over to him, intercepting him moments before he entered Room 5, where his wife lay, asleep for the last time and no longer in need of breakfast. I placed my hand on his arm and said something about “so sorry” and “bad news” and “just about to call you” — and as his face turned pale and his hands started to tremble, I broke into sobbing tears. I had to sit down, I was crying so hard. A nurse took him into Room 5, while I sat there, feeling like a total failure, and not sure why…
I probably “learned something” from that experience — I won’t bore you with the moral to the story or anything. But suffice to say, I’ve seen death, many times, and it has never become “easy” or “routine” for me. I hope it never will. And if I had to “go back and choose my specialty all over again,” I know that working with hospice and palliative medicine would be one of my top 3 choices. Bravo for you to work in a hospice — I’m sure you (will) have stories of death and dying to rival my own!