First death
I was reading this article about building clinician empathy, and one of the suggestions it made was to offer debriefing sessions for students and residents whenever their patients die.
I remember the first time I ever saw someone die.
I was a clerk (a fourth-year med student) rotating in Internal Medicine at a public hospital. It had been a busy night in the ER. I'd spent most of the day on my feet doing random tasks: IV insertions, blood extractions, patient interviews. My feet were aching for some rest.
Just when the workload was starting to slow, and the comforts of resting my butt on a monobloc chair resurfaced in my mind, someone's cardiac monitor alarmed. A series of fast, metallic, monotone beeps, barely audible over the usual ER noises. Beep beep beep beep beep.
Doctors rushed to him - a middle-aged man, morbidly obese, whose dark brown skin had an ashy undertone. He wasn't breathing.
The resident who was leading the team was cool and collected. She spoke in a clear, level voice, instructing the nurses to push vial after vial of epinephrine. At the same time, without even being told, the male nurses calmly formed a queue at the man's side. The nurse at the start of the queue began pumping the man's chest as hard and as fast as he could. It signaled the start of chest compressions, and I silently took my place as the third person in the line. As his body was being pumped, I couldn't shake the thought that the sound of the man's fat slapping itself coincided eerily well with the sound of the cardiac alarm. Beep-slap-beep-slap-beep-slap, went the morbid cadence.
A stranger thought crept into my mind: In the midst of the crowded and busy ER, resuscitating a dying man seemed an oddly peaceful process.
The thought occupied me until the nurse in front of me started calling my attention. He was finishing his turn with the chest compressions, and soon it would be mine.
The moment his hands left the patient's body, mine were there. I locked my elbows and started pressing - as hard and as fast as I could (although I knew this was not the proper technique, I had to comply with hospital culture).
10 pumps.
20 pumps.
30 pumps.
2 rescue breaths.
10 pumps.
20 pumps.
30 pumps.
2 rescue breaths.
In the middle of my next cycle, the resident called out, "Cardiac massage." The nurse behind me then asked to take over, and I was thankful he did because I didn't think I could muster any more compressions.
But what he did next was something I'd never seen before. Instead of pushing down on the man's chest, he appeared to be softly bouncing his wrists on his sternum. I was confused, but before I could question what was going on, the resident told me to go and fetch "the blue form" from the stock room.
The blue form, as I found out, is the death certificate.
When I returned, the compressions had stopped, the team of doctors and nurses had disappeared, this time replaced by a group of wailing family members.
It was a scene from a tableau: the deceased and his loved ones at the center, beneath a harsh fluorescent light, frozen in time as all the other patients looked on in stone cold silence.
I myself wasn't sure what I felt. Perhaps it was shock. There was no time to think about it. After signing her name on the blue form, the resident appeared by my side. "Doktora," she began her sentence in a soft tone. I thought to myself, this is it - this is the tender heartfelt moment where I'm going to receive advice about witnessing someone die.
"Pa-lagyan naman ng line yung bagong patient," she said.
"Yes doc," my obedient reply.
Indeed life moves forward. Mostly because it has no choice but to do so.
More patients poured into the ER entrance, completely oblivious to the fact that someone had just died there. And more tasks poured into my to-do list, enough to keep me occupied (and thoroughly exhausted) until the early morning sun up.
(to be continued)
I remember the first time I ever saw someone die.
I was a clerk (a fourth-year med student) rotating in Internal Medicine at a public hospital. It had been a busy night in the ER. I'd spent most of the day on my feet doing random tasks: IV insertions, blood extractions, patient interviews. My feet were aching for some rest.
Just when the workload was starting to slow, and the comforts of resting my butt on a monobloc chair resurfaced in my mind, someone's cardiac monitor alarmed. A series of fast, metallic, monotone beeps, barely audible over the usual ER noises. Beep beep beep beep beep.
Doctors rushed to him - a middle-aged man, morbidly obese, whose dark brown skin had an ashy undertone. He wasn't breathing.
The resident who was leading the team was cool and collected. She spoke in a clear, level voice, instructing the nurses to push vial after vial of epinephrine. At the same time, without even being told, the male nurses calmly formed a queue at the man's side. The nurse at the start of the queue began pumping the man's chest as hard and as fast as he could. It signaled the start of chest compressions, and I silently took my place as the third person in the line. As his body was being pumped, I couldn't shake the thought that the sound of the man's fat slapping itself coincided eerily well with the sound of the cardiac alarm. Beep-slap-beep-slap-beep-slap, went the morbid cadence.
A stranger thought crept into my mind: In the midst of the crowded and busy ER, resuscitating a dying man seemed an oddly peaceful process.
The thought occupied me until the nurse in front of me started calling my attention. He was finishing his turn with the chest compressions, and soon it would be mine.
The moment his hands left the patient's body, mine were there. I locked my elbows and started pressing - as hard and as fast as I could (although I knew this was not the proper technique, I had to comply with hospital culture).
10 pumps.
20 pumps.
30 pumps.
2 rescue breaths.
10 pumps.
20 pumps.
30 pumps.
2 rescue breaths.
In the middle of my next cycle, the resident called out, "Cardiac massage." The nurse behind me then asked to take over, and I was thankful he did because I didn't think I could muster any more compressions.
But what he did next was something I'd never seen before. Instead of pushing down on the man's chest, he appeared to be softly bouncing his wrists on his sternum. I was confused, but before I could question what was going on, the resident told me to go and fetch "the blue form" from the stock room.
The blue form, as I found out, is the death certificate.
When I returned, the compressions had stopped, the team of doctors and nurses had disappeared, this time replaced by a group of wailing family members.
It was a scene from a tableau: the deceased and his loved ones at the center, beneath a harsh fluorescent light, frozen in time as all the other patients looked on in stone cold silence.
I myself wasn't sure what I felt. Perhaps it was shock. There was no time to think about it. After signing her name on the blue form, the resident appeared by my side. "Doktora," she began her sentence in a soft tone. I thought to myself, this is it - this is the tender heartfelt moment where I'm going to receive advice about witnessing someone die.
"Pa-lagyan naman ng line yung bagong patient," she said.
"Yes doc," my obedient reply.
Indeed life moves forward. Mostly because it has no choice but to do so.
More patients poured into the ER entrance, completely oblivious to the fact that someone had just died there. And more tasks poured into my to-do list, enough to keep me occupied (and thoroughly exhausted) until the early morning sun up.
(to be continued)
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