“How could I witness the death of a patient and feel nothing?”
The first time I witnessed a death, I was a third-year medical student and at the very beginning of my training. My patient was older—in his late 70s—and all alone. His family dropped him off at the emergency department and were not reachable by phone.
One of my first nights on internal medicine call, he started bleeding from his gut and we couldn’t stop it. My supervising doctor told me he was going to die. I was called to his bedside at 2 a.m. because the nurse thought he might pass. When I walked into the room, I saw a pale, frail man with blood around his mouth taking shallow breaths. I didn’t know what to do or how I could help him. So I just held his hand and sat with him in his empty hospital room. After several minutes, he started vomiting blood and it was too much for me to handle. I tried to get up and leave, but he wouldn’t let go of my hand. I sat beside him as I watched the life drain from his body into stillness.
I felt this pit in my stomach. Stinging in my eyes. Like I had witnessed something I shouldn’t have seen. I walked to the nursing station, sat down, ate an entire box of chocolates that were at the desk and then I started to cry. I don’t think I’ll ever forget how I felt that day.
Seven years later, at the end of my residency, there was another patient I’ll never forget. But for totally different reasons. This 70-ish-year-old man was a handful—rude, belligerent with the staff and very unhappy to be in the hospital. He was getting a procedure that involved administering small shocks to his heart. While my entire team stood around his bed, and while his very loving wife sat beside him, I administered a sedative and the cardiologist administered the shocks. The heart monitor that had previously been beeping silenced and the heart tracing on his monitor went flat. Thirty seconds passed. Then 60 seconds. Still flat-lined. His heart had stopped. He was DNR and had explicit wishes not to be revived should this exact situation arise. So we stood around the bed and watched the monitor.
His wife’s sobs broke the silence.
“Is he dead?” she asked. “He was my whole life. I know he could be mean and horrible, but we’ve been together for 55 years. He’s all I have.”
My two medical students looked shell-shocked. One was crying and the other was looking at the floor and wouldn’t meet my eyes. I remembered vividly how I felt the day I first saw a patient die. And I realized that on this day, I felt nothing.
We gain a lot from medical training: knowledge, confidence, competence. But what do we lose? I realized at that moment—I had lost my innocence, the naïveté I had as a student. I expected to lose that. What I didn’t expect to lose along the way was my compassion, my empathy.
Those are the pillars that got me into medical school and the qualities I am trying to instill in my students. How could I witness the death of my patient—with his wife by his side, like a scene out of a medical drama—and feel nothing?
I’m not alone in my lack of feeling. Everyone in medicine has that moment when they see something tragic and don’t feel for the first time. Where they transform from a person connecting with another person to a provider treating a patient. Where the walls are up. After seeing countless deaths and tragedies, I pushed my empathy and feeling so far down because it made things easier. And now I’m working on pulling it back up to the surface.
Practising medicine is a great privilege, but it’s also just… hard. To have this insider knowledge of death. To look at someone and see their frailty. Their mortality. This is the blessing and the curse of the knowledge we worked so hard to learn.
We need compassion and empathy in medical practice. Because empathy—that unavoidable awareness and understanding of suffering—is one of the greatest things we can offer our patients. But balance too is important.
A version of this opinion piece was previously published by Associated Medical Services (AMS), a Canadian charitable organization providing support for the history of medicine, the education of health care professionals and strategic investments to address critical issues in our healthcare system. www.ams-inc.on.ca
Seema Marwaha is a general internist at Trillium Health Partners. She recently completed the Munk Global Journalism Fellowship, and is a past AMS Phoenix Fellow. Follow Seema on Twitter @SeemaMarwahaMD