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The Real First Death

(Written in 2014 during medical school)

It is well known that Medicine is a profession with death involved. People are patients, people die, and thus patients die. It is simple biology, it is the order of things, but it isn’t always easy.

Joining the medical profession, you go in with this knowledge. Just like any field, you anticipate your firsts, even from the most arbitrary of things until you get really good at it; your first venipuncture (now probably into the thousands in count), your first peripheral line insertion, first urinary catheter (but who really wants to do those), first time assisting in surgery,first time delivering a baby, and your first death.

When I was in my 3rd year of medical school in Jamaica, I had that “first death” to add to my census of firsts. I handled it like a pro, and thought, no biggie, I saw this coming. I’m glad she’s out of her suffering. Still, I will never forget her. She was a pleasant, elderly lady, who I took a history from the day before. When I asked her at the end if there was anything else she would like to tell me, she said, “The only thing I want to say is that Jesus is coming soon, and that people are not ready. They don’t even care. I’m afraid for this generation.” (I’m paraphrasing) The next morning, I came in and she was not doing well. She asked me to pack her things. I told my fellow student colleagues I didn’t like how she looked. Within 1 hour, she was dead…and that was it, simple, quick, I saw it coming, and I didn’t mind, she was old, she lived her life, she knew God, and that was that. Moving on swiftly, more patients to see.

Fast forward nearly two years later and I’ve seen my fair share of death,Ā (not too much, my patients usually recover šŸ™‚ #disclaimer)and I’m now in my senior medicine rotation. You can call me a more seasoned medical student, getting ready to enter the real world as a medical intern next year. I met a pleasant 42 year old woman I had the honour of taking on as a patient. As short of breath as she was, as uncomfortable as she was, she always made an effort to greet me with a smile when I came to her bedside. I can’t even continue to type without becoming emotional. This lady was born with Sickle Cell Disease, and had managed to go through her life without many exacerbations of the illness, however now she found herself with Pneumonia, that progressed rapidly, compounded with Acute Chest Syndrome, and after two days in hospital, she required admission to the Intensive Care Unit where she went into Respiratory Failure. Now intubated, and unable to speak, I told her to just say the name of Jesus in the quiet of her mind and that we were doing all we could to help her breathe and get better.

That day, I took her home with me, in my mind, she was critical, but I had so much fight left in me for her behalf. I wanted her to come out of this. The next morning, I came in and began heading to ICU to see her first, before any of my other patients…before I could even wash my hands at the entrance, one cold doctor said, “That lady died.” I literally felt like someone dumped a bucket of icy cold water on my head, shaky and alone…shocked…even though I shouldn’t be shocked. Yes she was critical, but this just wasn’t fair, it wasn’t right. I tried to gather my thoughts quickly, collect myself as a professional and proceeded to find her notes. Flipping through the pages, I somehow became illiterate, I couldn’t comprehend, I could not see, the tears were flooding my eyes. I kept telling myself to suck it up, this is what you signed up for. I had to leave. I found my best friend/colleague who told me to take a moment and let it out…and I did. Anyone who knows me well, knows I hate to cry, I will suck it up and bare the load without shedding a tear, but this time, I couldn’t hold it in. I wept.

I began to collect myself again, realizing that I have to move on with my day, repeating my mantra that this is what I signed up for, but I was afraid. Afraid to go check on my other patient who I knew was low. She, however, was an elderly lady who needed to be out of her suffering. She was already in hospital over a week, and really took a liking to me. When I went to see her one day she said in her frail grandma voice, “Oh I’m so glad to see you.” As I stood beside her bed with all the tools in my hand to take her blood I said, “You sure you’re glad to seeĀ me?Ā I’m here to take your blood, why are you glad to see me?” I was expecting herĀ countenanceĀ to change knowing she was aboutĀ to get a needle, but she said, “Because every time you come I feel better.” …My best friend said she would go and check on her for me, but I said no, I have to do it myself, after all, this is what I signed up for.

Now at her bedside, she took about three more breaths, and flatlined. She was DNR and allowed to go peacefully, without fuss. The nurse said, “She was waiting for you.” In that moment, the tears began again, not really for her, but just the heaviness of the emotion of that morning.

What they don’t tell you is, the first death isn’t your first patient that dies, it is the first one that you grieve. That is the real first death.