The first time I watched a patient die was also the first time I would ever see anyone die. It happened during M1, my first junior clinical posting in medicine. It was a night call. I can’t remember the circumstances that made me attend the call that night, because even now I hate attending calls as much as ever.
I was there that night with some other students and the chief registrar for medicine. He had taught us some basics: taking a patient’s oxygen saturation level (SPO2), setting a line, proper gloving techniques, and some other proper stuff.
Then, midway through that call, he was called into the A&E ward to see a patient who was in respiratory distress. Our patient was a dark, obese, middle-aged woman. I never got a clear look at her face; she was on an oxygen mask. I’m not sure how long she had been in the hospital or the exact circumstances in which she was brought in. She was unconscious, her whole body seemed to heave with every breath she took.
The flow rate of her oxygen was increased, but that did not help. She struggled like this for nearly an hour. The senior registrar told us she had a massive pulmonary embolism. I didn’t really understand the significance of what it meant then. But from his mood and his reluctance to discuss the case further, even though he’d been dishing out stuff on the cases we’d seen earlier, I knew it was bad. Later, he added that drugs could be given for the condition, but they were not very effective. The definitive treatment was surgery, but the equipment/facilities for this kind of surgery were not readily available in our environment. The woman’s family, her husband, and a number of children were allowed into the ward. They looked very concerned. The senior registrar (SR) spoke to the husband for a while, then later he told us that in conditions like this, where death was almost inevitable, it was best to prepare the family for it, rather than give them empty assurances.
Later on, the oxygen was stopped, and the doctors switched to CPR (I think her deterioration had necessitated it). A junior registrar and a house officer struggled to keep this woman alive for another thirty minutes or so. The SR maintained the same (should I say hopeless?) demeanour, working on a case note, perhaps the woman’s, while his juniors battled death with a CPR they knew would not work. I watched them continue tiredly, switching with one another on the chest compressions.
Eventually, the woman stopped struggling, and she was pronounced dead. I remember the wailing from her family members. I remember the husband speaking some Yoruba words to the dead woman. But one thing that struck me very clearly was the way the doctors had cleared out of the scene very quickly; it was something that looked practised. I was confused. I would later learn that they had to do that because sometimes dead patients’ relatives turned violently on doctors or anyone around with a white coat. I thought this was very sad. I still think so.
The other students and I cleared out just as quickly. The call that night was automatically over. If I remember correctly, the time was already 11. One or two of my classmates had cried at this death. The truth is that I couldn’t understand why. I wasn’t happy that a patient had died, but I couldn’t say that I was exactly sad either. For appearances’ sake, I tried to look sad and thoughtful. I slept off from exhaustion immediately I got to my hostel. The next day, I looked for the SR to sign my call and procedures from the previous night.
The memory still stays with me as one of many firsts. I think I remember all the times I’ve seen patients die at the hospital. I can’t say these memories are a burden, but I remember them. Most of these deaths were in less-than-ideal circumstances and it’s easy to imagine them surviving if our hospitals ran more efficiently, were better equipped, or if healthcare weren’t so catastrophically expensive for the lower members of society’s strata. While I can’t say I’m heartbroken about these deaths, it does make me wish that death is not as difficult on the dead as we sometimes imagine it.
I didn’t expect this kind of morbid turn when I set out to write this account, my bad. But I guess this is part of what you learn on this journey. A morbid turn can come anywhere, and anytime. But let’s not take anything I’ve said too deeply. Studying medicine is fun.
As narrated by: Jimoh Michael (Ilorin, Nigeria).
This snippet is published as part of the series, Surviving Medical School.
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