Reflections after the Death of a Patient
Written by Shelly Mishra, MD
On an evening in the hospital on my internal medicine rotation, I was chart-checking patients on my team. I realized that one of my patient’s was not on the list. I was informed that my patient, who had been improving from her initial presentation of severe hyperthyroidism and cachexia, had passed away from a sudden cardiac arrest. My initial reaction to this news was a state of confusion and shock. I had heard of patient death experiences from others and had even seen one during pre-medical experiences, but I had never experienced the death of someone who I was actively caring for. I thought about my interactions with the patient and the social situation surrounding her stay and was overcome with feelings of sadness and guilt. My guilt partially stemmed from a conversation I had with this patient about how she hoped to start walking again.
After some reflection about this experience, I have several key takeaways and important tips for medical students to remember:
Sharing. The first thing I did was call family and friends to make them aware that I wanted to reflect on the role of grieving in medicine. I also found comfort in talking to medical school friends about the way to reflect on a patient death. The empathy provided by medical school classmates for such moments in training can be immensely soothing.
Debrief. Many teams have the opportunity to debrief after patient deaths in the hospital. I requested a debrief with my attending. I was able to hear the efforts that the team had made in their care and investigation of this tragic event. Having a debrief is incredibly important for closure and to discuss lessons to learn in the future.
Writing. Find a journal, and write down your reflections. In the future, you can reflect on this memory of my life and reflect on future lessons. Writing helped organize my thoughts and focus on the bigger picture of medicine, caring for patients rather than solely the disease.
Lessons. Overall, the death of a patient is not just about the healthcare provider, but it is about the patient and their loved ones. However, as a medical student, there are lessons I’ve learned that will carry forth with me to better improve the care for my patients. This is also a reminder to ask every patient in the hospital about ways that I can help them achieve their goals. There are lessons to be learned every day in the hospital. I am grateful to have had the chance to meet this patient and learn lessons from my time with her.
