Daniel Orlan, M.D. ‘23 wrote this piece in medical school, reflecting on the experience of watching a patient die. He is now an emergency medicine resident in Miami. This article first appeared in “in-Training”, an online publication for medical students. The story that follows has been edited and abridged for FIU Medicine.
Facing the specter of death is an inevitable rite of passage for every medical student. The first two years, filled with theoretical knowledge, shield one from the visceral reality of mortality. Then, the transition to clinical clerkships unleashes a palpable tension as death looms in hospital corridors, echoed in code blue announcements and rooms occupied by comatose patients. For many, the apprehension and anxiety associated with witnessing a patient’s death are unwaveringly present.
Halfway through my third year, the avoidance of such an experience seemed plausible until I entered the realm of trauma surgery. Dread replaced anxiety, and an eagerness to confront the inevitable emerged. A professor’s advice to “rip the band-aid off” echoed in my mind. On my second night in trauma surgery, a level 1 trauma case arrived – five gunshot wounds, unconscious and frightened. In the operating room (OR), the battle against time and odds unfolded.
The operation extended to five agonizing hours. Bullet fragments had shredded the patient’s bowels, arteries bleeding faster than we could address. Epinephrine and fluids failed to stabilize his blood pressure. Two hours in, he coded. Chest compressions became my responsibility, ribs fracturing beneath my palms. The gravity of the moment hit me: this would be the first patient I witnessed die. Amid compressions and defibrillation attempts, a fleeting pulse offered momentary relief. Despite our persistent efforts, his pulse weakened, revealing an aortic injury with slim chances of survival.
A call interrupted our efforts – a child required urgent attention in an adjacent OR. Resources dwindled, compressions ceased, and the room emptied, leaving me, an intern, a nurse, and a dying man. His weakening heart barely sustained life. My duty was to monitor his fading pulse and notify the surgeon at the time of death. The room, now silent, allowed the weight of the moment to settle. Surprisingly absent were fear and dread; instead, sadness prevailed for a life abruptly ended. Yet, pride emerged, not for personal accomplishments, but for participating in the relentless effort to save a stranger’s life.
The inevitable stillness of the aorta marked the end. Suturing wounds with precision, we maintained a solemn respect for the gravity of our task. Facing death that day was made tolerable by the collective efforts along the way. Powerlessness in the face of death dissipates with small, meaningful actions. The first-hand realization that even in the darkest outcomes, clinicians can offer a fighting chance or comfort to the grieving underscores the essence of medicine. While fear and anxiety will inevitably accompany my medical career, recognizing the impact of small efforts becomes a source of empowerment and solace.
Medicine’s imperfections and the inevitability of suffering are acknowledged, yet the small differences made in patient care provide hope and meaning. These nuances, often seemingly minimal, define the essence of medicine, making the challenging moments bearable and reinforcing the pride and confidence in joining this noble field.