Shouldering the experiences in medicine is both a burden and an honor

I’ve been a doctor for one year. Two years of clinical rotations in medical school ill-prepared me for the reality of this job. Not that I went to bad medical school by any means; working in health care is simply something you can’t learn from a textbook or even on the sidelines as a marginally involved medical student. It is immersive.

Working around death and dying individuals can be mentally and physical exhausting, especially in an acute setting like a hospital. Only a few months of residency and everyone has at least one code blue story, that time that things went so badly it would be laughable if only the result hadn’t been someone’s death. There are team debriefs, moments of silence, chaplains who check in with family and staff alike. Code deaths are hard. The raw emotion in the setting of an adrenaline-producing experience is what emergency medicine and ICU folks seem to love and thrive on. But deaths on normal hospitalists teams are rarely that dramatic.

Outside of the ED or ICU, deaths more often happen on comfort care, in other words, hospice in the hospital. On the surface, these deaths are easier; no overhead pages, no running to the patient’s bedside, no mass of highly skilled nurses and doctors working in a controlled chaos to bring someone back only to not succeed. Instead, a page from nursing, a pulseless patient, a grieving family, and the quiet of a room.

We are conditioned in medical training that these are the good deaths, no painful procedures that wouldn’t change the outcome, plenty of pain medications for comfort, and time for family to say goodbyes. The privilege of holding a patient’s hand as they take their last breath is not something that I can begin to describe fully. But even these better, or easier, deaths take their toll on the physicians involved.

We pour time, energy, and compassion into the discussions that lead up to that moment of a patient passing. We do our best to learn the names of family members, to ask what would make you more comfortable, we pull strings to bring in animals for one last snuggle. We try to prepare families and patients for the dying process; we explain agonal breathing and what we will do to control symptoms. We do it because it’s our job, because we really do care, and because we know at some point we will be on the receiving end of such of a discussion for our own family members or ourselves.

Sometimes the news of the death comes as an afterthought “oh, your guy on comfort care died” I will hear in sign-out from the night team, or when I check up on a patient when I change services and see the dreaded, “you are opening a deceased patient’s record” message when trying to open their EMR chart. A year into my career as a physician the tears still come readily, though now usually in private. The moment of silence is held alone; there is no debrief session. We did our job, but in medicine, people die. Shouldering these experiences is both a burden and an honor.

Laura Selby is a physician.

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