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.

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