First Death

Bit tired of studying histology so the procrastination continues....
First Death.

So, I had my first emergency room preceptorship last week and while most of it was fairly familiar after working as a medical assistant and addictions counselor for several years, one part was not. I witnessed my first death. At the above aforementioned jobs, the people DT'ing, stroking out, or having heart attacks all got lugged off to the hospital just in time. Good for them by all means, but it always left me wondering what it would be like to actually witness their passings. A little morbid I know...but, I think most medical students are a bit intrigued by death and dying. In fact, part of the problem with our healthcare system is that we (really them-can't really pull that card yet), as doctors, are focused on the treatments, procedures, and drama surrounding death while we often fail to focus on the preventative measures that could of helped these patients long before.

Anyhow...the passing. It was sad. This 65 yo woman came by local ambulance, nonemergent, with c.c. of mid-back pain accompanied by fatigue and weakness. She was pleasant, alert, and in no acute distress. She had some atrial fibrillation which she reported that she had had since a young age but the rest of her EKG looked fine. I witnessed the extremely short physical and hx taken by the ER doc and labs were ordered and the decision was made to admit her because she could not support her own weight. The doc was not too worried about her though, no major problems, just needed a tune up in the ol' hospital. We ran around attending to other patients until we took a break in the office, when all of a sudden a nurse yelled requesting a doctor. We ran in to find the patient going into ventricular failure and we were about to shock her when the hospitalist ran in behind us and announced that she was "DNR" (do not resuscitate). The doctor put down the paddles and within seconds the 10 people in the room cleared out.

I could not believe it. I was the only one left and all I wanted to do was witness the event. It was still occurring. The blood vessels in her cheeks still pounded as if her cardiac output was just fine, her eyes laid open gazing ahead, and every once in a while she would let out a gasp. After dancing around the issue/concept and working with very sick people for so long, I almost felt relieved to finally see death. The passing was marked with little care, no ritual, and with no one she knew next to her. Besides the mid-back pain (a viscero-somatic indicator of cardiac malfunction), there was little on her arrival that indicated to me, as a first year student, that this woman would be dead in 45 minutes.