Why do some deaths hit harder than others?
Over the course of my eight years of medical training, I’ve been a part of countless code blues and pronounced many people dead. I have lost patients after months of caring for them. I’ve lost others I had just met.
This past weekend I lost a patient. It stung in a way that few others have. She joins a short list of three others that have hit me harder than the rest. She will stay imprinted in my memory forever.
Not quite middle aged, she was still young. Yet she had more health conditions and surgeries than a patient double her age. Born with congenital issues, she was no stranger to spending time in the hospital. She directed her care with certainty and knowledge. She knew when tubes, lines and dressings needed to be changed or moved; and the order in which they should be done. She was poised and assertive, her lived experience more valuable than my years of training. Her confidence hid her frailty, and this falsely reassured me she would make gains in rehab, despite sounding very sick on paper.
She was excited to be in rehab, to become strong enough to return home. Two days later, she died. Her body had run out of fight.
In my grief, I reflect. Why do some deaths – and not the countless others – stand out to me, above all the rest?
Maybe it has something to do with the patient themselves. Their age, their personality, their demeanor. Or maybe it is me – the stage of training I was in when I met them, or what I was going through personally that day. Maybe it has to do with the doctor-patient relationship we created together. Maybe it has to do with their diagnoses and their anticipated course of recovery.
With no unifying features to link the patient deaths that brought tears to my eyes, I still wonder why some and not others?
I like to believe I strive to treat all my patients equally. With care and compassion. With respect and dignity. Listening to understand what’s important to them and understand their lives and values. I get to know them and their families. I learn about their home set up and their hobbies. I learn about their past and present to help plan for their future. I learn about them so I can help improve their quality of life and functional status.
So why do some patient deaths hit me so much harder than others?
On this day, this particular death forced me to reflect in a different way.
We meet patients “on paper” – before we physically lay eyes on them, before we have a chance to talk with them and before we conduct a physical examination. Patients can sound very sick on paper. They often have long lists of prior health concerns, surgeries, complications and medications. But patients are so much more than their diagnoses on paper.
To me, patients exemplify determination and strength. They teach us about dedication, and show us how to follow through on achieving goals. They demonstrate resilience, even when facing an uphill battle. They show us what it truly means to have a fighting spirit. These qualities are never on paper.
Yet these are the qualities that drive me to help my patients through their difficult times. I am in constant awe of how patients confront their conditions. Their tenacity inspires me.
Hearing that my patient passed last weekend was a gut punch. Maybe this was because, on paper, she sounded very sick; but in actuality, she was a one woman army fighting her long list of diagnoses.
I may never be able to fully explain why some deaths linger and others vanish. Why I shut most out, but some bring me to tears, hurting my heart in an inexplicable way. While there may never be an answer, I am thankful to all the patients whose lives I have been a part of, whether at the beginning of their medical journey, or at the end. I am forever thankful to those patients that have brought me to tears and left a permanent mark on my life. I know that they make me a better physician.
As I am in my final few months of training, teetering on the precipice between trainee and staff roles, I feel the weight of my responsibilities shifting. It magnifies the insecurities of leaving residency and removing the safety net of being a trainee. It emphasizes that every medical decision I make for a patient hinges solely on my knowledge – creating anxieties about potential errors, oversights or medical missteps. Yet it also highlights the years of training, experience and dedication I have put in to practice indepentently. I am hopeful that each future death I encounter leads to further introspective reflection, allowing me to continue to grow as a doctor and a person.