On a foggy Friday morning late in the summer, I sat in the resident lounge of St. Anne’s Hospital with the rest of my team. As the primary inpatient team, one of our jobs was to cover any hospital codes. That morning, we heard the call for code blue: cardiac arrest. The code announcement is usually followed by the floor or unit; this time, it simply said “Radiology.” I was already halfway out the door, close behind the residents, but I realized in a heartbreaking second that this code wouldn’t be like the others we’d covered: the patient who had coded was almost certainly my patient.
As a medical student, I often moved from one rotation to the next so quickly that I don’t have time to get to know my patients. This doesn’t necessarily hinder the learning of pathology and treatment, but it does remove some human elements of medicine, and obscures the reason I wanted to be a physician in the first place: to build relationships. I remember learning at some point about boundaries in medicine, that doctors must learn to separate themselves from their work to protect themselves. This was something I understood intellectually, but as a medical student I more often had the opposite problem: I had so little relationship with the patients I saw that they rarely made an emotional impact on me at all.
John was an exception. He was a thin, 70-something-year-old man admitted for “confusion;” he had a remote history of esophageal cancer and little else in his chart. John was a clinical mystery which we never did solve. The first day we saw him, he thought it was November 1970, but appeared otherwise healthy. Over the next two weeks, he became bedbound, increasingly delirious, and stopped eating, eventually necessitating a feeding tube. We did an extensive workup, including a head CT, brain MRI, chest X-ray, blood and urine cultures, liver function tests, and blood counts, all of which were unrevealing. I saw him every morning, finding myself increasingly concerned as his speech became more slurred and his answers made less sense. Our team puzzled over his rapid deterioration; we eventually decided to get a lumbar puncture, hoping it would provide an answer. By this time, I was invested in the workup, but even more in his well-being. Since he was too weak by then to sit up in bed, he was scheduled to have it done downstairs, in the radiology department.
When we arrived on the scene, a few nurses were scrambling to stabilize John, one doing chest compressions and several working to hook him up to a monitor. One of the residents began to give orders; I tried, numbly, to make myself useful, but there isn’t often much for a medical student to do at a code. Consequently, when another resident turned and said, “Someone should call the family,” I accepted the offer before I had considered the assignment.
I paused. “Uh…. What do I tell them?” My chief resident looked at me. “Tell them… what’s going on, and to come to the hospital.” I walked down the hall, sat at an empty desk, and found the patient’s emergency contact information. I dialed the number.
“Is this Mary? Are you John’s sister?”
“Yes,” came the reply.
I can’t remember what I said, exactly; I somehow stumbled out the fact that his heart had stopped and we were trying to resuscitate him, and that they should get to the hospital as soon as possible.
“Are you serious?” she asked.
As a heart attack.
“Yes, I’m serious.” She hung up.
I walked back into the room just as they finished intubating him. By then he had a weak pulse; our team was preparing transfer to the ICU. My chief asked how it went, if I was alright; I told him fine. The other medical student put her hand on my arm.
In medical school, we often learn by doing. This was my first time calling a family to tell them their loved one was dying, and I had to learn, on the spot, how to say this kind of thing. I can’t even remember my exact words; I hope they were gentle and kind. Although I am tempted to think about how hard it was for me, I am forced to consider what it was like for that family. For me, it was a difficult experience from which I will learn, but for that family, an inexperienced medical student broke the news that their loved one was dying. For me, it was a terrible moment in a long day, but for that family, it was must have felt like the world was ending.
John was in the ICU for four more days, barely alive on a ventilator. The family came to say goodbye and signed paperwork allowing withdrawal of life support, and John died shortly after. We determined his cardiac arrest was likely secondary to a respiratory arrest from aspiration. We never found out what had caused his decline; I like to imagine the lumbar puncture would have given us a diagnosis, but I won’t know in this life. Seeing one’s patient die is a difficult thing, but it was all the more frustrating not knowing why. Death can often seem random, but for John it seemed unfairly so.
Even so, he helped to teach me about the line between doctors and patients, and the learning that can take place when we cross those lines and get invested. It allows us to see that what is hard for us may be unendurable for another. There is a place for boundaries in medicine, certainly for practicing physicians, but I think it was valuable for me to be tangled up, emotionally, in this case. It showed me the real meaning of empathy: considering life, and death, from the viewpoint of another. It’s easy to say this, but doing it, really doing it, is painful — but that pain might ultimately make us better healers, and better humans.
Brent Schnipke, MD is a writer based in Dayton, OH. He received his MD from Wright State University in 2018 and will begin residency training in Psychiatry this year. His professional interests include writing, medical humanities, and medical education.
