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
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Thank you Dr. Seema,
You cared for my husband with empathy and compassion in his first admission to Credit Valley, you provided your email so that I may request an update on his status. I respected that you shared a connection which many physicians are careful not to do out of fear that it would be abused. Hazem had 6 or 7 more admissions that year, I remember your name and continually speak highly of the experience of mutual respect that you initiated with us. More recently my manager at the Mississauga Halton LHIN, Corey Bernard has introduced me to your writing and I will share with others as well.
Hello from Gord. This is a great article. A note of thanks for sharing your thoughts on dealing with mortality, something that physicians and healthcare providers likely contend with more than most in society. Please know that we so appreciate the good work and positive difference that you folks make. We also understand that it must be difficult for folks to continually give of themselves in such a caring and selfless manner, and that coping mechanisms are also important for personal health. Your article helps us understand the realities and difficulties associated with striking such a balance. For those of us on the receiving side, thanks to all of you for the gift of empathy.
Thank you for sharing your thoughts. Indeed compassion and empathy are fundamental in health care. We need to think of how to better help each clinician or health care provider to cultivate compassion and empathy, instead of burying these qualities.
Compassion, empathy and such. Hmm, do the Health Technology Assessment and Evidence Based Medicine and Guideline academics teach this in Canadian medical schools and follow-up with continuing education courses for Canadian healthcare professionals? And deem this worthy? Someone I doubt it which is a sad reflection on the EBM paradigm of care and how our cherished health care professionals are supposed to act as EBM automatons where an algorithm can suffice for such compassionate and empathic care that is often required.
Thank you for writing that out so beautifully. This piece — just taking the time to reflect on and write it — makes it quite evident that you haven’t lost your compassion at all. And, if you ate a box of chocolate for every patient who didn’t make it, you would self destruct and not be able to keep doing the valuable things you’ve been doing, not just as a doc but as a Phoenix Fellow and journalist. It’s good to know you’re out there.
What an honest and heartfelt essay. Seema — don’t forget to have compassion for yourself, and forgive yourself for any perceived lack of feeling for your patients. How else could you cope in your profession? I doubt that you truly lack empathy.
Fabulous Seema…it’s beautifully written.I’m sure this happens to most of you doc’s but how many realize and work towards it.