Lines are slowly being taken out of the small infant, his bruised and discolored arms continuing to ooze. Machines and circuits, one by one, are being shut up and turned off. Leads and wires are carefully taken off of the lifeless chest of the once critically ill, but alive infant. Just hours ago, physicians, nurses, and other providers were rushing in and out of the room, desperately doing everything they could to keep this tiny child alive, and now silence, as the monitors are slowly turned off, and the alarms are silenced. In this growing silence, the unmistakable sob of a mother and father pierce the halls as the attending consoles them. Behind all this, the resident sits in the hall, typing up a note, laying out the events that had occurred.
Death is an inevitable part of life. It happens to everyone, and it is a natural progression of life. However, as physicians, we stand at a very unique position when dealing with the death of our patients. On one side is our human side, the side that is sympathetic, the side that grieves as we empathize with the patient’s family and their loss. On the other side, however, is the clinician, the side that made decisions in the care for this patient, the side that made the best medical decision we thought we could make. The clinical side is what makes death so unique for physicians, because there is often an element of guilt, a question if things could have been done differently.
While many times the answer is no, that question always arises for a physician, but even more so for a physician in training. As residents, we are continuously working and learning to be a better clinician, and because of this, the self-questioning is bigger. As residents, there will always be something that we can improve upon, something that possibly could’ve been done better. People say hindsight is 20/20, but as someone who is learning to see things as a seasoned doctor, you often wish you didn’t have to look back in the first place.
As a learning physician in the field of pediatrics, this sense of guilt is often bigger. The death of an adult is inherently different than the death of a child. When adults die, phrases like, “they lived a fulfilling life,” or “it was time for them to go” often come up. That is never the case in a child, even more so in infants, because just as we often say, “they had their whole lives in front of them.” When a child dies, I wonder about the possibilities, not just of what I could’ve done better, but also about what the child could’ve done or accomplished in his or her life. What impact could they have had?
But as I finish typing and signing the death discharge summary, I realize the huge impact that dying infant had on me. As residents, we are inundated with experiences that constantly shape our clinical decision making, and our future make up as an attending. In the midst of the self-questioning around a patient’s death, we are learning and growing as doctors. These experiences and our questions are molding the way we think and practice medicine and will be with us forever as physicians and help impact the lives of all those not only treat, but also teach.
Death is a part of life, and it is an integral aspect of a resident’s training, one where lessons are learned and always remembered. Whether it’s a death of an elderly or the death of a small infant, the profound impact it has on residents will carry forth to influence many others and in some way, that itself makes the death more meaningful. So as I watch the little infant being wheeled away, I say a quiet thank you for impacting me and my future patients forever.
Brian Han is a pediatric resident.
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