Dead. Gone. Passed away. Deceased. There are so many words that we often use to describe death. In healthcare, there are some that are used in private but never in front of patients. Some times you hear someone say he’s “DRT,” which stands for “dead right there” or “ART” for “assuming room temperature.” In a profession where you come face to face with the reality of your mortality, it becomes desensitizing and almost mundane. The current healthcare environment has made this even more real for some young people as they watch friends and family suffer and sometimes die from COVID-19.
At some point in your healthcare training, we talk about the stages of grief. First comes denial, which is followed by anger, bargaining, depression, and eventually, acceptance. I remember being taught these stages and talking about what the patient’s family would be going through. It was a matter of fact discussion that failed to prepare me for having to be the person delivering their friend or family’s status. We are taught to tell them we did everything we could but that the patient is dead or has died. It was very carefully explained that you are to use these two words instead of softer or what could be kinder things like saying they ”moved on to a better place”. One thing we never talked about was what to do after delivering the news. Do you pack up and leave abruptly? Do you walk out of the room? At what point is it okay to leave?
Death is an inevitable part of life. There’s a sense of rightness, a sense of justice when an octogenarian dies peacefully in their bed surrounded by generations of loved ones. Too often, this is not the case. We lose infants, children, teenagers, and young adults every day. The reception of friends and family in these populations is very different. When we first experience a patient’s death, it almost feels as if the pain is our own. Over time you lose another and then another and then another. After a while, you lose any emotional connection, and the continued exposure makes you numb. Death comes as a natural part of life, and you accept it, and over time you feel nothing. You become the Death Machine.
I’m not proud to say it, but I became a Death Machine. I could walk in a home and pronounce someone dead, advise the family, and walk out the door. Most of the time, I felt nothing. I was told over and over and conditioned to believe that I had to leave every emotion at home. I was to take care of the patient, provide them the best care I was capable of, and that even if I did everything right, the patient might still die. When I walked out the door and moved on to the next patient, I needed to start with a clean slate where there was no place for feelings and emotion.
It’s important to share that I had experienced personal loss. Death and the result of it was not anything new to me. I lost three of four grandparents before their 60th birthday. My parents were both dead by the age of 55. Classmates committed suicide or were lost to car accidents, drugs, and alcohol. I was no stranger to loss, and yet I still became desensitized to it. Being told by my mentors that we are not supposed to get attached to patients almost felt like permission to shut down. Except one day changed me.
I remember climbing into the ambulance and looking at the screen to see the dreaded dispatch code for OB/Childbirth. It had always been my policy that we don’t deliver in the ambulance. It leaves a mess and a smell that doesn’t go away for days. It’s also safer for the mother and infant to deliver in a controlled environment where they can be monitored. We drove to a nice, well-maintained neighborhood, and quickly unloaded our equipment. I walked upstairs to find a mother sitting between two chairs. A pile of towels beneath her laid a cyanotic infant with the cord still attached covered in meconium. Meconium is a sign of fetal distress, usually during delivery. When I started asking questions, no one wanted to answer me, and the mother never said a word. Only the husband and an older couple in the room ever spoke. Due to religious reasons, the mother never received prenatal care and refused to deliver in a hospital. I remember feeling a tightness in my chest as I opened the OB kit and quickly clamped and cut the cord. I scooped up that tiny human and started CPR as we rushed down the stairs and the ambulance. We initiated resuscitation and drove quickly to the nearest hospital. A few of the firefighters remained with the mother and awaited a second ambulance to bring her to the hospital. Despite my best effort, and the actions of the ER and OB staff, the infant died.
It wasn’t the first time I’d had an infant die. I’d had SIDS deaths and even a few that died while co-sleeping with parents or siblings. None of them hurt the way this one did. I can’t even explain why. I didn’t know the parents or the family or even this infant. But as I stood in the ER room door watching them repeat all of the things I had done and a few things I hadn’t, I felt the tears gathering in my eyes. My chest was tight as I realized that nothing we were doing seemed to make a difference. I stood there and thought that this wasn’t happening. I got angry. If only the parents had been at a hospital, then the infant would have survived. I proceeded through each step in rapid sequence until I hit depression. I felt this death in a way I had not felt any of my other patients in a very long time. Oh, how much it hurt! I realized how numb and burned out I had become.
I struggled with this run for a while. I ended up speaking to a Homicide Detective since all out of hospital deaths are initially evaluated as a homicide. I talked to the Department of Child Services and the Coroner’s Office. I had to relive those emotions so many times. My partner also struggled with the same sentiments. We talked about what had happened and how we felt. In a lot of ways, it was liberating to permit ourselves to feel. It was a situation where we both got stuck within stage 4, depression. What was the point of trying if it wasn’t going to work? I remember watching all the medical TV shows where no matter how terrible their injuries were, they always seemed to survive with normal neurological function and minimal long term physical deficits. For a while, working in the medical field seemed to be a joke since we never seemed to save anyone truly.
I eventually talked to a counselor, and over time I left the depression stage and finally found acceptance. It was a process but reminded me that it’s perfectly acceptable to have emotion. It can’t be permitted to prevent you from delivering medical care to the best of your education and ability. That counselor reminded me of so many things I had forgotten when it came to dealing with death. Even if my original patient died, my job was not finished. My job then became the family and caring for them. I didn’t have to deliver the bad news and run. And I learned to give myself permission to feel and sometimes cry and to embrace the pain. Learning to forgive myself for what I perceived as a failure was the hardest part.
When you work in healthcare, a patient will inevitably die at some point in your career. Life is not a gift that medicine controls. As medical professionals, it is our responsibility to care for our patients. Still, most importantly, it is our responsibility to care for ourselves. In a world where bad things happen, we need to care for one another. Hippocrates said: “Wherever the art of medicine is loved, there is also a love of humanity.” Sometimes you have to feel the pain, embrace it, and allow it to make you a more empathetic healthcare provider.
***If you are struggling with depression, loss, or need to speak to someone, you can call the National Suicide Hotline at 1-800-273-8255. AUC Students can contact the AUC Wellness Center.