One of my patients died today, the first time that I was actually around for such an event.
He was kind of a hopeless situation from the time he came in a few days ago, but we gave it our best shot. His family knew the prognosis was bad, and today when some tests confirmed that he had basically no brain function left, they agreed to withdraw care. I talked to them from the beginning, putting out the likelihood that he wouldn’t recover and that a decision would have to be made. Today I was trying to hide, letting subspecialists talk to them, but of course it wasn’t that easy. “Alice, we finished our discussion, now they’re asking to talk to you.”
The family seemed like great people, a strong family. They had a spokesperson who asked questions, and then announced their decision. I told them what we would do (having just carefully checked with the nurses, since I had never seen such proceedings myself). After the decision had been confirmed several times, we took them back to the room, and the nurse and I took out the breathing tube and left them alone together. I guess I didn’t really need to be there for that step, but I felt like he was my patient and I didn’t want to hide anymore.
I got in a corner and cried. I don’t know why, it was the right thing to do, and the family knew it, but they were so sad to lose their father, I couldn’t help it. Some time I should figure out at least how not to cry when I’m talking to the family, it doesn’t really help the situation.
About half an hour later I came back to check, and the nurse was printing an asystole strip off the monitor. So that was that. It took me three tries to fill the death certificate out correctly. (I have no idea how I’ve gotten to the twelfth month of internship without having had to write a death certificate before.) And then the coroner’s office wouldn’t answer their phone, and I had to keep calling and calling.
June 9, 2008 at 8:25 pm
I experienced my first patient death on day 3 of my orientation. I don’t think it matters when it happens the reaction is till visceral and odd. It is alot easier when there is no hope and its a clear decision, uncomplicated and somewhat expected. Thanks for sharing!
June 9, 2008 at 11:41 pm
I would much rather a surgeon that still has the capacity to cry for their patients.
June 10, 2008 at 12:34 am
Dr. Alice, I’m so sorry for your loss. But #2 is right – don’t lose your ability to cry over the deaths of your patients.
June 10, 2008 at 8:49 am
Wow, I’m sorry. I’m sure that was very difficult.
June 10, 2008 at 10:23 am
Thanks for posting such a personal experience. I don’t think crying is a bad thing. There’s a healthy tension between subject and object, or between personhood and physiological machine, or between art and science. When you cried, you’re remembering and recognizing the patient’s personhood.
June 10, 2008 at 10:17 pm
I still remember the first patient in my care who died…and it was 30 years ago. I agree with the previous writers–never loose your sensitivity to the loss of a unique person. I don’t always cry anymore on the outside, but I grieve the loss of somebody’s loved one and sometimes I grieve the circumstances that caused the loss.
As a family member of a patient who died in the hospital, I will NEVER forget the physician who hugged me with tears in her eyes after we made a decision similar to the family in your post. Her tears touched me deeply.
June 11, 2008 at 2:28 am
What DoctaJay says is quite right.
And soon you won’t be intern anymore, which must be a relief.
July 31, 2008 at 1:28 pm
Hi. I am pretty new to blogging, but not to doctoring. I was delighted to find your blog. Many other medical bloggers seem to use this medium for venting rather than sharing what moves them forward. I appreciated your story about losing a patient. I find this topic cropping up often in blogs by young physicians. I recently wrote a piece about losing a patient twice(!).