the first patient I would say was mine that was going to die, was my first 3rd yr rotation, peds
The first family conference where we discussed that Amy, a CF'er, wasn't likely to be extubated this hospitalization (news to me), and I looked into that mother's eyes, I don't know how I held it together. I often bite the inside of my cheek in those situations. The minute I was able to be alone, I just sobbed in the stairwell. I tried to hide that I'd been crying before heading to the workroom. The peds senior just said, "I know, it just seems so unfair, doesn't it?" very matter-of-factly, almost like my grief was a quaint idea. I wondered how they could deal.
Even after that rotation, later in the year, in the interest of "educational follow up," I looked in on Amy's chart from time to time. She was d/c'd that time, and she had a few repeat hospitalizations, each one grimmer than the last.
The first time I read "and we discussed that this was likely Amy's last Christmas" in the notes, I felt like I'd been punched in the chest. Again, I just wept. The funny thing, I hardly knew Amy, and what little interaction I'd had with the 13 yo, she was a little teen nightmare. Her mom was a real piece of work, one of those Jerry Springer drama mamas. Still, it was just unbearably sad, and all of that just made it all the sadder. Likely this child's life with CF was being cut so short because of neglect to her complex medical needs.
I knew from that moment on that I could never have a practice with sick kids.
To this day, I still tear up just thinking about it.
I was also there when my parent was in the ICU s/p MI, cardiac arrest. I had never been in the ICU and I had no idea what happened when people died there. I knew that my loved one was gone, and the plan was to discontinue life support. They were on the cooling protocol I knew nothing of then, I held their cold blue hand and wept, just wept for probably an hour while the rest of the family watched. We were closest and I guess I'm just a crier. Always have been, which has been one of my biggest challenges in maintaining the right face for my patients, hence the cheek-biting. I watched my parent seize from hypoxic brain injury, get extubated, breathe their last, turn cyanotic, and listened to their heartbeart stop with a stethoscope.
I'm actually extremely grateful for that experience.
How to cope? I think I focus on how lucky I am to get a front row seat to the drama of the human existence, to see things that others don't get the chance to, are too scared to, or just don't care for such things. It's a privilege to be part of someone's care up until their death. No one wants to die alone, and even if they don't know you're there, in the EMR clicking orders, writing notes, pumping their chest, you know you're there. That they didn't die alone. To have the bravery to look death in the face when we are all scared and instinct might say to look away.
I coped by bursting into tears sometimes. Crying myself to sleep sometimes. Talking to people I love outside of medicine, because I'm less afraid of those responses than I am from those within medicine, who maybe aren't in a good position to support your grief.
Then I try to be happy I'm alive. It's not too hard to find the extreme beauty in existence. I consider the beauty of plants and animals. I hug my cats and count their breaths and cry some more. I walk outside and pay special attention to the scenery, which in my case, is very green. I put on a nature documentary that's uplifting. I watch silly videos on YouTube. I come to SDN.
There's more patients to see, and life goes on, and at some point, you'll have that really positive interaction that makes you feel really good about being a doctor. And the circle is complete. Healing comes even if, sometimes upon reflection, tears still do as well.
