Patient care in medical school involves the two sides of a coin: recovery or deterioration of the patient’s health. Many medical students may not be fully prepared for the impact of losing a patient. Join Joy Muli, a medical student and Osmosis Medical Education Fellow, as she shares how to deal with a patient’s death using four coping strategies.
My first experience with a patient’s death in medical school
I knew I would have to face death often once I chose to pursue a career in medicine, but I don’t think I was ever fully prepared for it. In my third year, during my Internal Medicine rotation, I encountered a patient in dire need of resuscitation at the Accident and Emergency ward. He had been wheeled in following a grisly accident and was in a terrible condition. I was uncertain on what to do as it was my first clinical year, but I was willing to help in whichever way I could. What happened that evening is all so blurry to me.
A feeling of helplessness hung over the team attending to the young man; the hospital casualty ward was particularly overwhelmed that night, and ventilation machines were scarce. The manual resuscitation using the bag-valve mask became exhausting, my feeble hands needing frequent reinforcement from the more experienced nurses.
Then came silence amidst the buzzing of the machines in the Resuscitation room; a moment I’ll never forget. The ominous conclusion had to be made, even though I was in complete denial of it all. The doctor on call gave me a gentle nod, a signal to stop the manual ventilation. He then went on to record the time of death. The patient had died in our hands, right there on the resuscitation table in front of me.
I remember walking out of the Resuscitation room shortly after with many questions. I wondered whether as a junior student I had done the right thing. Did I make mistakes during the resuscitation process? Why wasn’t there any available ventilator?
The guilt and blame game only intensified when I thought through the bottlenecks in the system, including the red tape surrounding medical equipment that I had witnessed. Had all these factors cost the patient his life?
My journey home was a long one; silently wiping tears from my eyes, overwhelmed by all that had happened. I gave my family a brief explanation of what had happened once I got home in an attempt to debrief. But again I wondered: how much should I share with them? Will my constant stories about death be too gruesome for them to bear?
“How to deliver bad news” with Dr. Rishi Desai, MD, MPH.
Unhealthy coping mechanisms for dealing with a patient’s death
I’m now well into my clinical years but it’s still difficult to deal with death. I don’t think anyone can really say they are unfazed by it. Unfortunately, many see an emotional response to death as a sign of weakness—and even incompetence.
Some of the unhealthy coping mechanisms we can have as medical students include:
- Substance use disorders
- Becoming numb to death
- Suppressing emotions such as grief, despair, or sadness
- Internalizing/personalizing the death
Studying medicine puts one in an environment of great highs and great lows. Some patients walk joyfully out of the hospital; others are wheeled off into the mortuary. Amidst all this, we should face every day knowing that time and chance happen to us all. Which is why we must learn to appropriately deal with a patient’s death.
How can you cope with a patient’s death?
As medical students, we must be intentional not to ignore death, but instead, walk through all the motions accompanying death . So how can you cope with it?
- Empathize with the patient’s family: Give them the emotional support/comfort you can; a comforting word, a hug if it’s appropriate, etc.
- Express how you feel: Grieve if you must. Take some time to cry it out or journal your thoughts as this will help you process your emotions.
- Seek counselling and grief support services: To offer a sounding board for any guilt/false thoughts you may have internalized following the death of a patient.
- Prioritize self-care: Frequently carve out time for activities you enjoy, offloading emotional stress that could lead to burnout and compassion fatigue.
As you face a patient’s death, remember that the death may be a megaphone reminding you that life is fleeting, but in the same breath, it is a gentle whisper reminding you to be thankful for every moment of life you still have.About Joy
Joy Mueni Muli is a fifth-year MBChB student at the University of Nairobi. She is originally from Nairobi, Kenya, and plans to go into Oncology. She enjoys writing on her personal blog and having deep conversations about life with friends and family. You can also find her engrossed in her books one moment and bursting out into song the next—a true creative scientist!
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