Watching someone die and feeling … nothing

The first time I witnessed a death, I was a third year medical student and at  the very beginning of my training. My patient was older – in his late 70s – and all alone. His family dropped him off at the emergency department and were not reachable by phone.

One of my first nights on internal medicine call, he started bleeding from his gut and we couldn’t stop it. My supervising doctor told me he was going to die.  I was called to his bedside at two in the morning because the nurse thought he might pass. When I walked into the room, I saw a pale, frail man with blood around his mouth taking shallow breaths.  I didn’t know what to do or how I could help him. So I just held his hand and sat with him in his empty hospital room. After several minutes, he started vomiting blood and it was too much for me to handle. I tried to get up and leave, but he wouldn’t let go of my hand. I sat beside him as I watched the life drain from his body into stillness.  I felt this pit in my stomach. Stinging in my eyes. Like I witnessed something I shouldn’t have seen.  I walked to the nursing station, sat down, ate an entire box of chocolates that were at the desk and then I started to cry.  I don’t think I’ll ever forget how I felt that day.

Seven years later, at the end of my residency there was another patient I’ll never forget. But for totally different reasons. This 70-ish year old man was a handful – rude, belligerent with the staff and very unhappy to be in the hospital. He was getting a procedure that involved administering small shocks to his heart. While my entire team stood around his bed, and while his very loving wife sat beside him, I administered a sedative and the cardiologist administered the shocks.  The heart monitor that was previously beeping silenced and the heart tracing on his monitor went flat. Thirty seconds passed. Then 60 seconds. Still flat lined. His heart had stopped.  He was DNR and had explicit wishes not to revive him should this exact situation arise. So we stood around the bed and watched the monitor.

I started to hear his wife’s sobs break the silence.

“Is he dead?” she asked, “he was my whole life,” she said. “I know he could be mean and horrible, but we’ve been together for 55 years. He’s all I have. “

I looked at my two medical students and they looked shell shocked. One was crying and the other was looking at the floor and wouldn’t meet my eyes. Looking at them, I remembered vividly how I had felt the day I first saw a patient die. And I realized that on this day, I felt nothing.

We gain a lot from medical training: knowledge, confidence, competence. But what do we lose? I realized at that moment – I had lost my innocence. That naiveté I had as a student. I expected to lose that.  But what I didn’t expect to lose along the way was my compassion, my empathy.

Those pillars that got me into medical school and the qualities I am trying to instill in my students. How could I witness the death of patient of mine – with his wife by his side, like a scene out of a medical drama – and feel nothing?

I’m not alone in my lack of feeling.  Everyone in medicine has that moment when they see something tragic and don’t feel for the first time.  Where they transformed from a person connecting with another person to a provider treating a patient where the walls are up.  After seeing countless deaths and tragedies, I pushed my empathy and feeling so far down because it made things easier. And now I’m working on pulling it back up to the surface.

Practicing medicine is a great privilege, but it’s also just… hard.  To have this insider knowledge of death. To look at someone and see their frailty. Their mortality.  This is the blessing and the curse of the knowledge we worked so hard to learn.

We need compassion and empathy in medical practice. Because empathy– that unavoidable awareness and understanding of suffering – is one of the greatest things we can offer our patients.  But balance too is important. As I pursue and understand the learning and practice of compassionate care as an AMS fellow, this delicate balance is top of mind.

This blog post, written by AMS Fellow Dr. Seema Marwaha originally appeared on the AMS blog in 2017.