A first death

Closing in on the end of the residency year, most of the interns have earned their first death. Some took their time. Some didn’t have to wait too long at all. All in all, I find that the reactions that they have to death are quite different and sometimes offer a unique insight.

The experience of death is a little different for each of them. Getting called by the nurse at 4 AM and being told that Mrs. R expired is quite different from being the person pumping on Mrs. R’s chest, and even this is more insulated than being the person having to tell Mrs. R’s family that there’s nothing more that we can do. And all of this is easy compared to being the person who forgot to write for an antibiotic for Mrs. R’s positive blood culture.

When a patient dies, some of the interns are relieved. The patient is no longer going to torture the intern with really hard decisions and clinical questions, many of which are life or death types of choices. It’s all over now. No more stress. Maybe the intern can get some sleep now.

Some are utterly devastated. There was so much emotional involvement, and now, no outlet. It feels like gas in your stomach, and you can’t belch it out. And it hurts in a deep way that can’t be easily resolved. You can’t talk yourself out of it. Some people drink themselves out of it.

And sometimes, every now and then, you’ll meet someone who just doesn’t care. They take the news of their patient’s death with the same attitude that someone from Nebraska would have about the Mets losing the NLCS.

I thought for sure that I would be the destroyed person when I had my first death. I thought it would empty me out and hurt me in ways that I couldn’t even comprehend. But surprisingly, I found myself in the ‘don’t care’ column. A nurse called me to pronounce on a patient that was DNR. I went to bedside, pronounced the patient, and then went back to bed.

Since then, I’ve had a lot of other death experiences, and they’ve run the gamut of relief to devastation. But I’ve always felt a little guilty about Mrs. R. Not that I did anything wrong per se but her death was so forgettable to me, and that my reaction was not one of sadness, but of relief.

I’ve since had some surprisingly hard deaths, deaths where I was so angry and so disappointed with myself that I threw things and slammed doors. I punched a door so hard that I thought I broke my hand. And I remember one death where I went balls to the wall in treatment, I talked the family out of a DNR, and after 8 hours of very aggressive treatment, the patient had a systolic pressure of 50/20. I talked to the family and we went to comfort care, and I threw things and cursed and was so angry. I did everything right, and even then, I failed.

Each death is a little different, and in the end, I find that it helps to insulate yourself a little. Each death hurts, and rather than pouring yourself out each time, it helps to ration out your compassion a bit. I know it sounds cold, but the human soul can only bear so much suffering.

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