Dealing with Patient Death

A few months ago, as I held a bloody heart in my hand, I lost my first patient. I was only a second-year medical student at Keck School of Medicine and this was my first time shadowing at a Level One Trauma Center. The patient was a Jane Doe, barely alive when she arrived by ambulance. She lost her pulse seconds after she was transferred to the hospital bed. I was surprised by how quickly the whole team responded. As some doctors yelled for blood and another pushed epi, a couple of residents immediately made a large cut to open almost the entire left side of her chest. They used a tool to push her flesh and ribs apart and took the heart right out of the cavity. I was in awe. I had never even heard of an emergency thoracotomy before this and now, here I was, witnessing the procedure.

One doctor stuck his hand into the Jane Doe’s chest cavity and called me over. I wasn’t sure what to expect when he asked me to put my hands inside the patient’s chest. Before I could make sense of the new experience of being inside a living human, the doctor handed me the woman’s heart and told me to start pumping. I literally held her naked heart between my hands as I rhythmically squeezed. I blocked out the commotion and focused on my job. I only took my hands off when the doctors shocked her with something that looked like a salad tong, then I got right back to it. I could hear them in the background yelling for blood and working on keeping her alive. A few minutes later, as my hands still pumped her heart, they called her time of death.

They were frustrated, but used this experience to teach the residents. They asked, “What could we have done better?” The doctors commented on how they could improve their fluidity as a team, but in the end, they acknowledged that they did everything in their power to save this woman’s life. After most of the doctors left, a few residents showed me how to sew her up and I closed her. And naturally, I couldn’t help but wonder if I killed her. What if I was squeezing at the wrong pace? What if I wasn’t squeezing hard enough? Was I squeezing too hard? “Do no harm.” That’s what we’re taught. What if I had broken the fundamental rule doctors are supposed to follow? The doctors could see the shock and fear on my face. They must have known what I was thinking because they reassured me again and again that her death was not my fault. It took a few days of reflection for me to actually believe that to be true. I replayed the scenario repeatedly in my mind and realized there really wasn’t anything more I could have done.

Unfortunately, as a doctor, I’ll have to experience patient deaths. But the lives saved more than make up for it. Like the patient I had later that night, a man, I’ll call GC. He came in with a head laceration that he got while trying to protect a stranger. Someone shaved and numbed his very bloody head and I helped staple his scalp back together. I gave GC warm blankets and stayed to talk to him. He told me I did a great job and right before I left that night, he prayed for me. After losing Jane Doe, I thought I’d leave the emergency department in shambles. I was devastated and I couldn’t understand how the physicians there could experience this daily without breaking. But after bonding with GC, I found myself eager to return. Helping such a selfless patient was a rewarding feeling like no other. Yes, I was still very sad and mourned the death of Jane Doe, but the gratitude I felt after helping GC greatly overshadowed my grief. I would have never guessed it, but he had a greater impact on my outlook of medicine and my future career than the first patient did.