When a patient dies, do you cry?

Apparently, I wanted to become a doctor since I was four. My mother tells the story of me getting ready for bed and simply saying: “Mommy, when I grow up I want to be a doctor so I can make people better.”

This notion stuck with me, and, luckily, I took a liking to biology, anatomy and all the sciences throughout school making my little four-year-old dreams come true. And now, here I am.

When you decide you want to become a physician, the reason is usually to help people get better, especially when you’re a child. The concept of death doesn’t reach a child’s mind until somewhere between the ages of five and seven. You don’t think about this other side of being a doctor, and it really isn’t until quite far along the process of schooling that you make that realization: “Wait, there are going to be people that die; I won’t be able to make everyone better.”

I was always told that you will never forget when your first patient dies. This statement holds true for me. It was an October, and two patients of mine passed away in the ICU only a few hours apart on the same day. I remember their daughter and son in the room when it happened, the daughter just hugged me and cried, and of course, I cried with her. It was an emotional moment that I will never forget.

A few hours later, an older gentleman without any family slowly drifted away, and I went to another room and cried in silence until I pulled myself together. I was told by a senior not to worry because dealing with death will get easier with time. I always wondered to myself if that is truly a good thing.

I admit that, with time, it did get a bit easier, but it was mostly just easier to keep it together when I was with a patient and their family. I have always allowed myself to fully express my feelings, usually when I was not in the eye of others around me. I had a safe word I would repeat in my head anytime the situation took a turn for the worst, and I felt the tears building up. If a patient began to cry or other family members cried, I couldn’t stop myself from imagining what it would feel like to be in their shoes. What if it were my own mother, father, grandmother or brother? I would feel those tears starting, whether the patient was young or old, if the death was anticipated or if it came by surprise. Interestingly enough, for reasons I cannot explain, I would repeat the word “tomato” in my head over and over, usually for about five seconds and it would distract me enough to stop the tears right away.

As I write this article, I worry about becoming numb to something that I feel should be an emotional experience. Physicians are trained to bring life into the world, keep them healthy and be there when the inevitable circle of life ends — whether it is to try to turn things around for a patient or lend a helping hand of support to a patient and their family when nothing more can be done.

I have had countless experiences with death in the hospital. Recently, four years after my first patient experience, I had a comfort care discussion with a patient whose diagnosis was cancer with metastasis to multiple sites at the time of diagnosis who had been sent home but worsened very quickly and came back to the hospital. While I was speaking to him he began to cry. I felt a few tears slowly drip down my own face. Of course, I quickly regrouped (tomato) and got myself together. I held his hand and asked him a simple question:”What is most important to you with whatever time you have left?” He told me he just wanted to watch basketball as long as he can. It brought a smile to my face, and I told him we will try to help him achieve this goal. As I drove home that day, I left myself feel what I felt in his room, true sadness and guilt that I could not help him get better.

Of course, we are the doctors, and patients look to us for support, answers, healing and to help them through the emotional process of dying. I can say one thing, I still cry when dealing with death, and I am glad. One day when I am dying, as we all will, I would gladly have a doctor taking care of me that appreciated the beauty and sadness in life and death and allowed themselves to feel it. I agree that we need to be a rock for the patients and their families, and we should try to be composed during this difficult time. But I do feel completely losing the emotion of sadness during this time can be unhealthy for us.

I don’t know what is the right answer to this question, or if there is even a right answer, to begin with. Should we become “used to” seeing death since we are surrounded by it so often? Or, is it something that we should always allow ourselves to fully feel? I know that no matter how many years I practice medicine, I will always cry when a patient dies. I can’t imagine becoming numb to something that I find so precious — life.

I understand we are all individuals who have had different life experiences and have found our own ways to process these things, so I ask the question: When a patient dies, do you still cry?

Jasmine Toor is an internal medicine physician.

Image credit: Shutterstock.com

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