excerpt from The Rules of Medicine by Sonya Sloan, M.D. (Coming Soon)
RULE#18 LET THEM GO | DEATH
1 the action or fact of dying or being killed; the end of the life of a person or organism.
Patients die. It may be a truth that we as medical professionals try to evade, but cannot escape. Try as we may, we do loose some battles. Death is an undeniable reality for all of us. But now apply devastating things like cancer, unsurmountable episodes of sepsis, or monstrous events like head-on collisions, to an inevitable date with destiny. It is only then you will realize that you are just a pawn in this thing we call life and medicine.
The first patient I thought I killed (but for the record, I did not) was a gentle giant of 89 years, and had served his country valiantly. As an intern and newbie at a medical hospital, I was finding my way around and getting the lay of the land. When I heard, “CODE BLUE SICU, CODE BLUE SICU” my heart froze. I had made rounds earlier with the surgical staff and my upper level residents who were checking out to me, the resident on call. I knew there were only two patients to really be concerned about and both were on our service in the SICU! As I ran up the stairs to the SICU, my heartbeat became louder in my ears and my mind raced with possible problems and solutions to the reason my patient was coding. As I arrived at bed 9, I jumped into action and tried everything I knew to save his life. I checked his ventilator, the central line, the chest tube, and each pharmaceutical medicine that ran through his continuous IV drips. Within seconds of my arrival I pulled the crash cart and was just about to shock (defibrillator) him when I realized I was the only one on the code team taking heroic measures. And then, out of nowhere, I heard the voice of reason from that old nurse. You know the nurse who doesn’t usually tell you how to do your job, but is always right because she has seen and done more than you as a doctor in training. She never raised her voice, but clearly and calmly she said, “Enough, let him go! PATIENTS DIE!”
How cruel and cold of her, I thought. It was my duty to save this man. More importantly, or at least so I thought, I didn’t want him to die on my watch! I did not desire the dubious obligation to have to tell his family he had passed and was no longer with us. Not on my watch! And I sure as hell didn’t want to do the in immense amount of paperwork that goes along with a code, death and discharge so to speak. My stomach churned at the idea of facing my senior staff in M&M (morbidity and mortality), a meeting where all surgical staff and teams discuss what may have gone wrong with the care of a patient). It is sometimes seen as My Mortality since you feel as if you are crucified. And lastly but not least I could not endure the jeers of “You can’t keep a patient alive” from my peers! But my ‘on call coverage’ patient was circling the drain, and no amount of medications or surgical procedures were going to stop him from meeting his maker on this particular day.
Sometimes as medical professionals we get in the way of something as powerful and nonsensical as death. Death cannot be reasoned with nor bargained through. How freakin’ arrogant are we to think we can stop death from occurring? Delaying the inevitable, yes, we do that pretty well. With all of our fancy research and state of the art technology, we can prolong the inevitable for a while in most cases. But sometimes we should say no more. We should look death in the face, open the door and let nature take its’ course. I admire Anthony Giddens’ perspective as stated in Modernity and Self-Identity, “Death becomes a point zero: it is nothing more or less than the moment at which human control over human existence finds an outer limit.”
Perhaps as medical professionals we academically learn about death and grief but never truly understand it in as an applicable practice. Psychiatrist Elisabeth Kubler-Ross discusses the 5 stages of grief in her 1969 book “On Death and Dying.” There are other mental health experts who have since outlined other models involving 3 to 7 stages of grief. But the gist is that you will go thru denial, anger, bargain, depression and acceptance. There really is no right or wrong Kubler-Ross only suggested a way to categorize or explain a portion of what the heart and mind goes through in coping with death and grief. We as medical professionals tell others about these stages of grief, but do not necessarily apply them in our own practice and after math of our daily losses.
So here are a few of my suggestions to be help you let them (your patients) go:
- Be where you are (own your emotions)
- Know and accept the stages of grief
- Change your perspective (death is not your adversary).
- Know that the death is a part of the process of life (and you are a part of it).
- Remember that it is an honor to take care of a patient as they leave this world.
- Remove your selfish lens and help the patient not to suffer.
- Always do your best (and know that you did), have no regrets.
There is a beautiful sculpture on front façade of the Fulton County Department of Health and Wellness building in Atlanta, Georgia. Built in circa 1961, the sculptor is believed to be Julian Hoke Harris. The sculpture is an image of Asclepius and The Grim Reaper. Asclepius is the son of Apollo in Greek mythology a.k.a the God of healing who is fighting off death. The sculpture is a perfect reminder of the power of current day medicine. We as medical professionals need to know when to strong arm death, and fight for life another day. But just in case you find yourself in the alternate position and death is winning or worse whooping your ass, then I remind you PATIENTS DIE! You should welcome it and accept it, respectfully.