“And in the end, when the life went out of him and my hands could not work no more, I left that place into the night and wept-for myself, for life, for that tragedy of deaths coming. Then I rose and walking back to the suffering house forgot again my own wounds, for the sake of healing theirs.”- Anonymous ER Dr

Death is inevitable. At some point in your life, everyone will have to deal with the death of a loved one or even just acquaintances who somehow made an impact in your life. e.g Some one who you walk past and greets you every day. The way people  deal with death is by being surrounded by family, friends and support groups as they have experienced similar losses(Smith, M. Robinson, L. Segal, J. 2019).  You are also given time off to mourn the death of a person.

Losing a patient in a clinical setting is different to losing a loved one. You are not given time to mourn as you have other patients to attend to. You mourn on your own, this usually happens when you leave the clinical setting. There is no-one you mourn with, you are somehow scared to talk to the family or you don’t see them. You do not talk to clinicians as you are uncomfortable or you might feel like you are wasting their time. A study conducted on foundation year doctors experiences of death and dying showed that only 11% of the participants received support from consultants and educational supervisors(Linklater, GT, 2010). I experienced this during my first block.

My first 4^th year block was at Paarl Hospital, during this block 2 of my patients died. This was the first time I lost patients due to death. I had a feeling that one was going to die but not the other one. I somehow could deal with the one’s death, but not the other one that was sudden. A qualitative study done on the effects of patient death on medical students in the emergency department showed that unexpected deaths were more emotionally moving than expected death(Batley, N. et al. 2017)

I cannot remember the specifics of the patient, but what I can remember is what happened and how I felt. This patient was initially seen by my clinician and then she handed him over to me. I can’t remember what his diagnosis was, all I know is that he had a laparotomy and my clinician asked me to check his chest and mobilise him to a chair. The first time I treated him was on a Tuesday and on that day I was unable to mobilise him to a chair as he was to weak and I could not mobilise him alone and no one was around to assist me. I then saw him the Wednesday, he was feeling stronger and I was able to mobilise him to the chair. The doctors were at his bedside while I was mobilising him and was complimenting him on how strong he is and how nice he’s sitting. The Thursday morning my clinician gave me my patients for the day like she does everyday. I looked at my list of patients and saw that this patient was not on the list, so I asked my clinician about him and she said that he had died.

I remember that I wanted to ask her, how? When? What? But I could not say anything, so I just said okay and left the room. I kept on thinking that I caused his death. The rest of that day and the following week I could not stop thinking about this patient, I was also more careful with the management of my other patients. I realised that the University does not prepare us for this. It is only in our 4^th year where we talk about death and even though we talk about it, we as students do not know how to deal with the death of a patient.

This raises the question of how does the university prepare students to deal with the death of a patient,so that it will not have an effect on the treatment of other patients and to ensure that the mental health of students are good. A study done on death as a learning experience for undergraduate medical students suggest that students should be educated on death in a clinical setting and trained on how to deal with death before going on clinical rotations. It also states that it should be integrated, rather than isolated in the curriculum. Staff should be trained on how to support student when they experience death of a patient(Smith-Han, K. Martyn, H. Barret, A. Nicholson, H. 2016). I fully agree with suggestions and conclusion of this study. I did not talk to anyone about this experience and I think that is part of the reason why I still think about this patient today. I would encourage students who go through this to talk to family, friends, lecturers and fellow students.

References

Smith, M. Robinson, L. Segal, J. (2019). Coping with Grief and Loss. retrieved from https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm

Linklater, GT. (2010). Educational needs of foundation doctors caring for dying patients. J R Coll Physicians Edinb. 40:13-8.

Batley, N. et al. (2017). The effect of patient death on medical students in the emergency department. BMC Medical Education. 17:110

Smith-Han, K. Martyn, H. Barret, A. Nicholson, H. (2016). That’s not what you expect to do as a doctor, you know, you don’t expect your patients to die.” Death as a learning experience for undergraduate medical students. BMC Medical Education. 16:108