If you’d told me as an F1 that I’d have loved my placement in Palliative Medicine, I’d have laughed. But working in an environment where death was normalised – and where the focus moved to how to make people comfortable in their last minutes, hours, or days – I found it immensely comforting.
I haven’t always been this way. As a 25 year old medical graduate, I wasn’t good with blood. I’d wince at the sight of a used plaster in the swimming pool. The closest I’d been to death was doing CPR on a dummy and breaking bad news to an actor. All uneventful, and certainly not the real thing. I’d lucked out with my first placement in Urology – no real sickies, so I didn’t get any deaths.
My second placement changed that.
I found myself in Vascular Surgery at Bedford Hospital, in a constant whirlwind of emergencies. But my first death found me on a weekend day shift, writing discharge letters when the crash bleep went off for a cardiac arrest.
I panic. I don’t even remember where the bleep wants me to go – I have to listen again. I run out of the office, expecting to see a flurry of doctors attending to an emergency, but I don’t see anyone. Just a flashing light at the end of the ward. I run towards my patient, and it’s just me – and I’ve not even done my Advanced Life Support yet.
I don’t recognise the patient, but I call his name. I check his radial, his femoral – there’s no pulse. I start doing chest compressions immediately, but they’re too shallow. Twenty seconds later, the registrar runs through, pushes me off, and takes over. I stand back and watch, and suddenly, it seems like every single staff member is on the scene. I’m passed a half full ABG syringe, and I run to the machine, five floors down. The numbers aren’t promising, but I rush back to show the team anyway. It’s the least I can do.
After half an hour, the decision is made. There’s no active sign of life. CPR stops, and the hallway empties again, and I’m left to my discharge letters as if nothing has happened. After procrastinating for half an hour, I go back to work. I felt useless.
I feel useless thinking about it. I think a lot about how I could have improved. I still go back to that moment a lot – and the only way I can really sleep at night is by thinking that nothing I could have done would have made that much of a difference. Yes, if I’d done Advanced Life Support maybe it could have gone smoother – but it’s unlikely that it would have changed the outcome.
How do you deal with your first death? I don’t think there’s an easy answer – it happens slowly, and thinking about myself in the ward after that, it took time to process.
Here’s the advice I do have:
- Always ask for help – if you’re the only doctor on the scene, an experienced nurse can be your best friend.
- Make sure you take care of yourself and give yourself time and space to process the event. Don’t forget to eat and sleep properly, even if you don’t feel like it.
- Talk to your colleagues – particularly to people who are slightly your senior. They’ll have been where you are before. It’s good to hear how other people manage that, and to talk about death rather than only dealing with it when it happens.
- Be prepared where you can – book your ALS sooner rather than later. Check the iResus app to prepare. If only for the psychological peace of mind, it’s worth it.
Even though I’d been through years of medical school, it took my first death to realise that doctors aren’t superheroes. Sometimes you get lucky, and sometimes you don’t.