Medical Students Don’t Learn About Death

The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.

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Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.

I have never been sure whether to consider myself lucky or unlucky. Is that a morbid way to think about it? That maybe I was lucky (and my patients were lucky) that they didn’t die on my watch? That maybe I was lucky that I hadn’t had to experience those awful and heartbreaking conversations with a patient’s family. In the Russian roulette game of hospital care and medical education, I felt spared.

At the same time – and I feel almost selfish for saying this – I considered myself unlucky. I had never been around a dying patient. I had never known what it meant to take care of someone in their final days. I had never had the opportunity to learn and grow as a person and a physician from those difficult moments.

My first clinical experience with death was during my sub-internship, with a woman with end-stage ovarian cancer. I had scrubbed in on her most recent debulking surgery, and I had followed her post-operatively. Though her overall prognosis was poor, she was progressing well after this most recent operation. Her pain and abdominal bloating were slightly improved. She was even about ready to go to a rehab facility; all the arrangements had been made for transfer.

But then she started failing – started not being able to get out of bed. Started being more confused about herself and her surroundings. Started sleeping more of the day. She was physically and mentally breaking down. The cancer burden was overwhelming her body, and she was not able to hold up.

This experience was undoubtedly sad, but the experience for me was compounded by the suddenness and relative unexpectedness of it all. “She was not dying when I met her!” I naively believed.

She did have terminal cancer, after all.

The emotional impact was heightened for me because of the fact that only one of her family members was with her until the end. I felt bad that nobody she knew from outside the hospital was there for; yet I hope our medical team was able to be a somewhat second family to her in her final days. I visited in on her, spoke with her relative, did everything non-medical I thought to try to make her comfortable (I didn’t know much).

When she passed, I imagined the briefest moment of stillness amongst the chaos, but the hospital quickly moved on. There was no closure, no reflection, almost no conversation. When the other team members who had helped take care of her found out the news, there was a general statement of sadness, but then it was back to work as usual. There was more work to be done, other patients to take care of.

I heard that the nursing and floor teams held a small commemoration for our patient later that week (as they do for any patient on the cancer floor who dies). I wasn’t aware it was happening, and I’m positive none of the medical team was present.

Do doctors not mourn, too? Don’t we all need a moment to breathe, to reflect on our relationship with that patient, and to acknowledge our emotions about their passing?

Why don’t they prepare us for this?

 

Image source: Stanford.edu

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23 comments

  1. being a medical student and soon to be doctor i can relate myself very well and being a doctor in India i see a lot of death everyday .. death seems to have no more emotional value to me .. sometimes i have nightmare that i may laugh or not shade tears in funerals of my own .. its a natural price we pay .. nice article ..i would like to hear more from you ..

    Liked by 1 person

  2. Great article–I work in pediatrics, and often find myself a bit jealous of the increased exposure to end-of-life experiences that my adult medicine colleagues have. Not that I want patients (especially kids) to die, but I think it is helpful as a physician to have exposure to patient deaths in order to prepare you for similar events in the future. I’ve had several patients die, and I think the hardest ones are those that happen in the ER, when there’s no time to process or reflect…just 8 new patients on the board.

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  3. Reblogged this on NorthernMSW: Advocacy, Aging, Healthcare & Social Work Issues….. and commented:
    This quote struck a cord with me: “When she passed, I imagined the briefest moment of stillness amongst the chaos, but the hospital quickly moved on. There was no closure, no reflection, almost no conversation. When the other team members who had helped take care of her found out the news, there was a general statement of sadness, but then it was back to work as usual. There was more work to be done, other patients to take care of.”

    This is not how it should be. Physicians and nurses along with orderlies and nurse assistants need training, support and good supervision.

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  4. As a pediatric ICU nurse who is married to an ED physician, I’m part of a household that deals with this stuff on a pretty regular basis. I;m not sure we’re ever really prepared for the death of a patient. It always surprises me how I’m affected by it, even after 5 years of practice. Yes, doctors (and nurses) mourn. We need at least a moment to take it all in before letting it go and moving on to the next patient… it sounds like you’re handling it exactly as you should. I always tell myself that if dying patients didn’t make me sad, it would be time for a career change.

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  5. I really appreciate this post. I am a third year medical student and really relate with you on “…I considered myself unlucky. I had never been around a dying patient.” Saying that medical school has taught me a lot is an understatement. However, you’re right in that the “curriculum” does not typically prepare us on how to appropriately grieve for our patients. I have also experienced similar moments of “missed grief” with leaving acute or critical patients that I have been taking care of, during the transition between rotations.

    I’m really happy to have stumbled on your blog during this time in my education. I look forward to reading about your upcoming match!

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  6. i am impressed by the amount of reflection you do! if only every medical student would do this, they would all grow so much more as people!
    As a medical student and an intern, I used to take all those stories home, and tell my parents and siblings about it. I would not be the only person mourning, at the end of the day! My family would be mourning for a child or adult whom they had never met!
    At some point in life, you have to learn to let go of the pain and move on. Trust me, it is not callousness. I guess it is a protective mechanism. If we don’t develop some ability to move on, we would burn out much faster, and would not really be able to give our best, to the next patient we have to care for!
    Great writing! Love your posts!
    Raji

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  7. Well writing 🙂

    My sister has recently passed away in ICU. I’ve heard from my family that my sister’s last doctor was so cold. The doctor kept telling my family that to give up my sister, and that my sister would not be alive right away while my sister was still fine. I wonder if some doctors eventually become cold and numb after seeing so many deaths?

    I am not a professional, I don’t know a lot about medicine, and I am not saying every doctor are bad, but please read this if you can:

    https://halfbrighthalfdark.wordpress.com/2015/01/01/doctorskillers-and-hospitalsexecution-ground-a-major-issue-of-medicine-abuse-in-taiwan-醫生=兇手,醫院=執行/

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  8. Thank you for blogging this article, it is hopeful to see young professionals being this reflective. Please keep writing about your experiences, it is nice to get an insight in how you experience your work.

    In the Netherlands (where me and my flock graze), we see the difference between doctors and nurses. The doctors are not there for mourning, they are there to diagnose, operate and give medicine. After that, they move on to the next patient, and the next. It’s the nurses that do all of the empathic / ‘human’ work with the patients who not only get diagnosed, operated or given medicine, but lie in bed 24 hours a day, experience their illness and need attention, like every other sick individual does if he would be a child and back at home with his mother. Ever since we have been in the hospital for operations many times now we see how much value society must place on this concept called ‘nurses’..

    We hope that you don’t get tangled up in the web of time management, seeing 50 patients an hour, and that you keep your human touch 🙂

    Liked by 1 person

  9. I totally agree, from the moment we start to study medicine we believe that doctors could save everyone and heal every disease but that’s, unfortunately, not true

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