Encountering death and how it has affected how I practice medicine

The untimely death of Chadwick Boseman forced me to recount my numerous encounters with death and how it has affected how I practice medicine and view aspects of morbidity and mortality. 

My initial encounter with death was during college. I was volunteering in the ICU and truly tried to delve into the pathophysiology of shock and why some patients were candidates for advanced therapies while others were not. I remember discreetly that this particular day was different. A patient that I was following, suddenly had a sudden impending sense of doom and became extremely agitated. He kept screaming to the medical team that he was “going to die” and he was going to a place that we would not be able to join. Suddenly, there were several bells and alarms that went off and the nurse started screaming for help from that patient’s room about 3 hours later. This was the first time I had watched someone code…the first time that I had a first hand experience with death. CPR was performed on the patient for what seemed like an eternity. And the patient never came back…exactly as the patient stated it would happen. The family was sitting in the waiting room and I could hear the wail from his significant other down the hallway, as I saw the attending physician disappear into the family room. I was stunned and I couldn’t shake the feeling of feeling like there was more that could have been done. I felt numb,  but I also wasn’t extremely surprised because only old people die, right? 

My subsequent encounter was when I was a medical student during my trauma rotation. The patient was a 31 year old male who was randomly stabbed several times during a party. The patient went for an emergent exploratory laparotomy and also coded in the operating room. I also distinctly remember that it was 2:35 am on a Friday night. I quickly jumped in line to perform compressions because that was what you did as a medical student, right? I completed all of 10 compressions and the anesthesiologist asked me to stop compressions because they wanted to pronounce his death. An immense sense of fear and grief drenched my skin just as sweat was dripping down the small of my back. I suddenly became nauseous. I could feel tears bubbling from the back of my throat and I quickly excused myself from the operating room and found a lonely corner to cry. This man was only a few years older than I was. “Did I not push his chest hard enough?” “ I asked myself. “Was his untimely demise because of something that we did as a care team?” I could not stop sobbing and I carried that night with me for the rest of my rotation. I no longer had first hand experiences with death during medical school. However, some of my classmates had multiple encounters. Some of them could not cope well with each of the deaths; while others seemed to causally become numb to the deaths that they encountered. Some of them explained to us “emotionally attached ones” that we just had to see them as individuals that “could not be saved.” It was at that point that I promised myself that I could not be as callous as some of them had become. 

My most recent hospital encounter with death was last week. I was the new fellow on the CICU rotation. Another relatively young patient coded after having a heart attack. His code was a surprise to all of us. An hour before, his significant other was explaining how he had taken the last 6 months to lose 25 pounds and he had truly turned his life around. I was stunned and could not bring myself to shake the overwhelming feelings of surprise and doubt that I had about his prognosis while the CPR was being performed on him. Around me, people talked about their plans for the weekend and what the next consultation would be. I was in utter disbelief at what I was hearing. I could not believe that we were at a place, yet again, where someone’s life was in our hands and I was experiencing utter callousness from some members of the care team. 

With each of my encounters, I have had to face aspects of my own mortality and the mortality of the ones that are near and dear to my heart. I have reminded myself that each of these patients have family members that love them and care for them. Most of the patient’s that have died do not come to the hospital and expect outcomes such as these. And it is up to us physicians to remember this. It is up to us to remember that there is a human being with family members that are relying on us to take matters of life and, particularly, death seriously. 

And on that note rest in peace to the forever Black Panther, Chadwick Boseman. 

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