The death of a patient

Sometimes I think that one of the most important goals of medical school is to gradually inoculate future doctors against death.

Six weeks into medical school, we walked into a room of naked cadavers lying on metal tables. The first cut, conveniently scheduled to be into the skin of the back, was difficult. After that, it was easier. For 10 weeks, we experienced death less than we experienced the body—removing the skin to examine the muscles, cutting into the chest to remove the heart, finally reaching into the abdomen to feel the liver and kidneys.

Later, we were made to witness an autopsy. The body lay on the table, a wife and mother who had committed suicide. She had a tattoo on her ankle. This was different than our cadaver. This person had a family, a story. I felt nauseous, and not only because the room was warm and the protective equipment we wore was hot. Still, after the first cut and after the face was covered, it was anatomy again. Muscles, heart, liver, kidneys.

It makes sense that these experiences would exist in medical school. Doctors need to be less bothered by death than most people. We treat the sick, and the sick often die.

Still, no amount of exposure could have prepared me for the first time I lost a patient.

As fourth-year medical students, we are expected to act as our patients’ primary physicians while they are in the hospital. We are supervised by a resident and by the attending physician, but it is our job to check in on the patients, follow up on their lab results and collect the advice of expert consultants, among other details of patient care. Though the broad decisions are made collectively by the team (and realistically, the more experienced team members make the decisions), fourth-year medical students are tasked with knowing and managing the minute details of patient care.

And so it was that when my first patient died it really felt like my first patient died.

Mr. B was a Vietnam vet with a host of medical problems. He came into the hospital with a skin rash, probably from an antibiotic he had taken, that stripped the top layer off of his skin. The skin seems like no more than a covering, but it is a covering that keeps moisture in and infection out. Without that protective barrier between our flesh and the outside world, we run the risks of dehydration and overwhelming infection.

From the time I got home the next day until the time I got back to the hospital, I thought about Mr. B. What could I have done differently? What could I have done better? With perfect hindsight, it was easy to think of changes that the team could have made. I grew horrified. Could this have been prevented? I thought some more. At every step, we had done our best. I knew we had thought carefully and worked hard to do what was right. Still, I did not feel better.

I next thought of the moments that Mr. B and I had shared. In the long course of his life, they probably were insignificant to him. In the course of my life, I doubt many things will mean more. I know I will never forget him. I hope he will always be a reminder of the tenuousness with which the sick grasp hold of life. I hope he will remind me to talk to my patients, to learn who they are, to connect with them as people, because by lunchtime, they could be gone. I knew I had learned something from Mr. B.

As a doctor, my patients will die. Mr. B taught me I could live with that reality, as long as I tried my hardest to keep them healthy and treated them with humanity while they lived.

I felt better.

Alex Fanaroff is a fourth-year medical student. His column runs every Wednesday.