The first time I saw a patient die

By Aaron Kovacs

The first time I ever saw a patient die was just over two years ago, only a month or two into my first clinical placement as a third year medical student. She was an older lady, maybe in her mid sixties, with advanced uterine cancer. The resident and I found her lying on top of her bed, eyes wide and fixed in place, her body rigid as concrete.

We as human beings are fascinated by death, even if the reality of it doesn’t quite meet our morbidly romantic expectations. It’s not anticlimactic so much as it is unexpected; dead people don’t look like they’re sleeping – they look dead. The apparently simple gesture of closing the eyelids of a recently deceased patient is met by physical resistance that isn’t accounted for in Hollywood’s dramatised depiction of dying.

I watched the resident go through the eerie ritual of declaring the patient dead, placing his stethoscope to her motionless chest, feeling her neck for an absent pulse. ‘I hate doing this,’ he murmured, shining a penlight in her unresponsive eyes. And with a glance at his watch, the patient officially died. We covered her body in a white hospital blanket and left for the next job: the reams of paperwork that awaited.

Sometimes we look to rationalise the deaths of patients, finding comfort in the idea that ‘it was their time to go’, but the truth is that that isn’t always going to be the case. There are the elderly patients that pass on in their sleep, and then there are the ones that are rushed to the emergency department and aspirate on their own vomit as the medical staff make attempts to intubate them.

We experienced the latter a few months after the first patient. He was a middle aged man, in his forties or fifties, brought in by ambulance after suddenly collapsing while shopping with his teenage son. The emergency department was a flurry of activity, with staff rushing to the unconscious man’s cubicle. We students were called on to help with CPR, a few minutes at a time, stretching on and on, until suddenly —

‘We’re going to stop compressions.’

Almost dreamlike, the entire emergency department stepped away from the patient and everyone resumed what they were doing beforehand. The normality of it was startling, but of course there’s always another patient in the waiting room.

What hit me hardest after losing both of these patients was the feeling of emptiness that their deaths were accompanied by. It’s not sadness as such, but the sense of loss is tangible. Worst of all is knowing that someone has to break the news to the patient’s family left behind. There’s something completely absurd about the tutorials we attend in our first year focusing on how to console the grieving individual when many of us have never experienced loss ourselves.

But these moments are necessary parts of our medical training, experiences that teach us how we and others deal with loss and grieve in our individual ways. I’ve learnt that a patient’s death does not necessarily equate to failure; being able to ease a patient through the last chapters of his or her life is one of the greatest successes possible in the practice of medicine. It’s easy to see life and death as two polar opposites, but the reality is that death is just one end of the spectrum. It is as much the doctor’s role to guide patients to the end of their lives as it is to ‘save’ them.

There’s nothing dignified in the physical process of dying. We watch ourselves age, our bodies growing frailer until they finally give way, our bodily functions oblivious to the embarrassment it would have caused our living selves. But it is an end we universally face. It is up to those who live on — friends, family, nurses, doctors and students alike — to imbue it with the dignity death lacks, to make something beautiful out of a messy biological process.

Featured image available at Wellcome Images.

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