Hearts, Exposed – A Medical Student’s Reflection on Witnessing Their First Patient Death

By Erik Carlson

“Hospital’s on lockdown.”

The security guard didn’t even throw us a backward glance as he shouted the news over his shoulder before continuing on his brisk jog around the floor. I turned to the chaplain I was shadowing that Friday afternoon. A Dominican sister from the Dominican Republic, she called herself a “Double Dominican.”

“Why is the hospital on lockdown?” I asked, trepidation coloring my voice gray.

“That’s hospital procedure whenever they bring in a gunshot victim. Would you like to go? They’ll need a chaplain, so I’ll be going.”

During our first year, my medical school requires students to shadow a chaplain in the university hospital. These chaplains, who come from a variety of faith traditions and backgrounds, address the emotional and spiritual needs of patients, often liaising between the medical team and the patients’ families. Before entering the hospital that afternoon, I was determined to put aside any preformed notions about healthcare and spirituality and to approach the experience with as open a mind as possible.

After more than two hours of holding hands, praying with strangers, consoling families with terminally-ill loved ones, and accompanying those without a support system, I was both emotionally and physically drained. I couldn’t imagine seeing another patient, yet the thought of returning home to a Friday evening with my anatomy notes spurred me onward toward the ED, one step behind the chaplain.

Together, we rounded the hallway and entered the commotion that was the emergency department’s trauma bay. I squeezed into a corner, trying to make myself as small as possible. The victims were two men who looked to be in their late 30’s. Their clothes were being cut from their bodies as masked physicians and nurses sought the sources of the bleeding. Over the shouts of the caregivers, the first man locked eyes with me. His deep, brown eyes, oscillating between fear and listlessness, beseeched me as to why he was there and who was I to witness him at this moment, the most perilous and vulnerable of his life.

Unable to hold his gaze, I turned away and caught sight of the chaplain standing on the periphery of the circle of providers and onlookers. As there were no family members of the victims needing comforting at the moment, she was searching each of our faces to see who she would need to console; who would need to be checked in with when this dense, frenetic moment inevitably came to a close and the staff would be expected to continue on as if nothing had happened.

Still unnerved from the first man’s penetrative stare, I looked over to the second patient in the neighboring bed. Unable to start a pulse and having exhausted all other options, the doctors broke open his chest and began to perform a cardiac massage. The tension in the room rose as desperation charged the physician’s compressions.

And then, as quickly as the chaos had begun, it came to a quiet close. The first patient was stabilized and wheeled away. The second was not as fortunate. The doctor removed his grip from the man’s heart. Cursorily shedding his blood-stained gloves, he turned to his colleagues and discussed what went right and what they could improve upon for next time. Presently, both the trauma bay and the minds of the ED staff would be wiped clean of this affair. The needs of the next patient demanded such.

My mind, which had slowly been retreating inward, was wrenched back to the present. My glazed-over eyes instantly cleared as unwelcome tears found their way to the surface. What had I just witnessed? Who are these two men? Why did this happen to them? I blinked the tears away. My chest was cracked open; a feeling of vacuity settled into my gut. And into that dark hollowness, fear crept in and took root. What if my response to death with this sterile emptiness continues into the future? What if in the long medical career that lies ahead, each time that I encounter death, my response will be to feel nothing at all?

Instead of asking myself the typical medical student question – Do I have it in me to pass the next exam? I found myself asking about my personal fund of grace and compassion – Will it be enough?

The chaplain caught my eye and could tell it was time to go.

As she walked me out of the ED, she gently took my hands and inquired, “How are you?” Despite having witnessed the dying process of hundreds of patients; despite having asked this question thousands of times and having asked me more than ten times so far that day, I knew she meant it in the sincerest possible sense.

“I’m… okay.” I said, lamely. And then, with her prompting, I dug deeper. “Why did this happen to these men? What life circumstances led them to this moment? Why is this city so filled with violence? And more selfishly – What is my role in all of this suffering?”

As these thoughts poured out of me, she listened in such a way that conveyed that at that moment I was the most important person in the world. She validated all of my feelings of confusion, fear, and frustration. She also challenged me to sit with some of my questions. She held my hands in hers and left me with one piece of advice: “In your career, you’ll have a choice: to be a physician or a healer. Be a healer.”

I turned to leave. My mind moved to my classmates.

We will not be able to go this path alone. Our task will be to meet this wounded world with some semblance of grace, to be alert to its lessons, and to not be afraid to ask for help. We will need to provide one another the space to explore our hearts and to share these stories. We have to show each other that our feelings of grief, often veiled by the demands of professionalism, are real and true; to remind one another that we too are completely and fully human. The commitment to being healers must begin among our peers.

And when we fall short of the ideals of care we would like to provide to our patients, we ought to invite chaplains to step in to heal where we may have naively sought only to cure. They will be the ones standing on the margins, reading the faces of all those who ache, poised to ask the questions that patients and physicians alike need to hear: How are you? How may I best support you?

I paused for a moment to give my heart the space to feel. A heavy sorrow replaced the nothingness, and my soul ached for this man, his family, and his community. I smoothed the wrinkles in my white coat and started walking forward. The hospital doors slid shut behind me.

 

Erik Carlson is a second-year medical student at Loyola University Chicago Stritch School of Medicine. He is in the dual MD/MPH degree program with a concentration in global health equity. He is considering a career in infectious disease.

 

6 thoughts on “Hearts, Exposed – A Medical Student’s Reflection on Witnessing Their First Patient Death

  1. From Rainer Rilke’s “Letters To A Young Poet”:
    I want to beg you, as much as I can, dear sir, to be patient toward all that is unsolved in your heart and to try to love the questions themselves like locked rooms and like books that are written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.

    I have been a chaplain for thirty years, and am now Manager of Clinical Ethics for our Health System. My last night of on call as a chaplain before assuming this new, I was called at 11 PM to a rural ER an hour from my home. A Gulf War Veteran completed suicide with a gunshot wound, and I accompanied his wife and others at the bedside. We all accumulate stories where we were with people at turning points in their lives. I love the chaplain’s words about being a healer rather than a physician. I hope that my career (two years from retirement) reflects my attempts to be a healer and a compassionate presence rather than my knowledge of theology and counseling technique.

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  2. As a medical student, your time for reading anything outside of your medical textbooks is, I’m sure, little to none. But maybe you could get these two books to keep close by for when you have a minute here and there….the author of both is Rachel Naomi Remen, who is an M.D.; her books speak to the kind of issues and feelings you describe in your moving essay. The book titles are Kitchen Table Wisdom, and My Grandfather’s Blessings. All the best to you as you continue your schooling and move into the world of being a healer.

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  3. see Wald HS, Reis SP, Monroe AD, Borkan JM. ‘The Loss of My Elderly Patient:’ Interactive reflective writing to support medical students’ rites of passage. Med Teach. 2010;32(4):e178-84. PubMed PMID: 20353317.
    Hugs Eric
    Shmuel reis

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  4. Thank you for sharing your experience. As a faculty and resident educator, I have witnessed heartwrenching experiences, and often wonder where each person learns how to manage the grief, the self-doubt, and the will to draw upon tragedy as a learning experience. These are things life teaches us, usually through a long journey. In medicine, nursing, public health, veterinary medicine and other health sciences, students encounter myriad experiences like this. And it begs the question how do we best serve our students in managing their grief and stress so that they can bring what they learn to bear on their next experience and to become the professional who supports their peers and learners in doing the same. There is no easy answer, but your reflection suggests a good start – we ought to formally include chaplains, social workers, and therapists in this process. Someone qualified to listen to and monitor the well-being of our students, and guide them through one of life’s most arduous journeys.
    Thank you again.

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