The critical moment1 (slide 18) in my life, I believe, came when I volunteered as a nurse assistant at a local hospital, during which time I first witnessed a patient die. The patient, who was a Jehovah’s Witness adherent, had refused care despite having been in critical care for several days. This was a relatively small and under-staffed hospital, so I was charged with more responsibilities than warranted my position. Other than cleaning up, I was also asked to liaise with the relatives to accede to a blood transfusion. I happened to be in the room, when the patient actually died. I went into the room to find the convulsing patient obtunded and hypotensive. I immediately called for help, but when I returned to the room, the patient gasped a few more times and collapsed back into the pool of vomit and blood.
This proved to be a terrifying experience. I recall a sense of inevitability and dejection on the part of the doctors and nurses helping the patient. While I felt that they were emotionally disassociated from the situation, I was not. I felt deep sense of responsibility for the patient not only because I thought I should have come sooner, but also because I had formed a close attachment to the patient and his relatives. I was gutted, and for the subsequent days, I remember sense of grief, shock and helplessness. While I had seen countless cadavers and had had several patients in my care, I had never had a patient that I had grown so close to die as I watched. The transition from a living, breathing, speaking patient that defiantly resisted care to a retching, helpless mess of blood and vomit was frankly, frightening.
Prior to this experience, my perception of patients was business-like, because they were simply tools to earn better grades, as against people who were in pain and need. The actual experience with a person losing his life and actual professionals in the field making death-and-life decisions helped me understand that people were not simply case studies. The experience made me alive to the career path that I had chosen. I know I wanted to be a doctor, but I had not thought of the possibility of losing lives. While mistakes in school only cost a grade, in real life, it cost lives, livelihoods, happiness, careers and families. This realization forced me to see a doctor that I wanted to become within me, which felt was very different from the student. I realized that I was overly obsessed with grades and great residencies as against the actual job that I was training to do. Since this experience, I have cultivated a healthy appreciation for the patients and my future role as a doctor. I have adopted an entirely new approach to learning because I realize I do so to gain the requisite competency to be a healer as against simply passing exams.
I am not a stranger to death or disease, but the violent nature incident forced me confront my inner fears about death and a doctor’s responsibility in providing care to the patient. The incident was brief, but nonetheless influenced my understanding of my responsibility as a medical practitioner’s in a real life experience. The contrast between the sterilized morgue and textbook experience paled in significance to the loss of a life that I had grown accustomed. The difference between the textbook experience and real life experience also shows through the fact that the patient’s religious beliefs proved to be a major determinant of the nature of care that they received. Chang and Kelly2(p 1) assert that appreciation of the patients’ cultural values and beliefs is an intrinsic component of good quality care, which is why it is critical that health care practitioners learn just as much about cultural beliefs. Patients are not lab rats or cadavers. Lastly, in trying to cope with my own grieve due to the experience, I established that as health care practitioners, it is not going to be possible to always disassociate myself with my patients. It is perfectly normal to develop attachments to my patients and grieve for, or with them. Shorter and Stayt4(p 165) believe that compassion is a major aspect of a practitioner’s motivation and willingness to cooperate to ensure the best possible outcomes for the patient, and thus needs to be encouraged.
Conclusion and Action Plan
Medical schools famously attract that brightest and best-motivated students with a zeal for helping other people. While there is no shortage of brains in lecture halls across the world, even with notoriously frustrating residency applications, stressful residencies and rotation grades, few of them fully understand or are prepared for the job. In fact, this experience helped me to understand the very reason for the rigorous residencies and field experience. Medical students and other health care practitioners need to gain genuine appreciation of the varied practice aspects in order to ensure competency and efficiency. Other than mastering the course content, the exposure makes for a deeper understanding of the hidden curriculum, including culture, interpersonal relationship and communication.5 (p1) I fully understand and even expect to experience numerous similar incidents such as this one in future and if this should happen, I intend to:
- Provide competent assistance to the patients so that if they pass on, I will not be left with a sense of guilt
- Understand such incidences are a part of my job
- Approach my studies with a focus on my future competency as a doctor as against simply passing exams
- Develop a full appreciation of the socio-cultural context in the delivery of health care2(p 3)
- Holden-Rachiotis, Caroline. Reflective Practice. Lecture Notes, RCSI Royal College of Surgeons in Ireland Bahrain: 2008.
- Chang, Margaret, and Ann Kelly. "Patient Education: Addressing Cultural Diversity and Health Literacy Issues." Urol Nurs. 2007;27(5), 2007: 411-417. .
- Shorter, Melanie, and Louise Caroline Stayt. "Critical care nurses’ experiences of grief in an adult intensive care unit." Journal of Advanced Nursing 66 (1), 2010: 159–167.
- Stroebel, Christine K., Reuben R. McDaniel, Benjamin F. Crabtree, William L. Miller, Paul A. Nutting, and Kurt C. Stange. "How Complexity Science Can Inform a Reflective Process for Improvement in Primary Care Practices." Joint Commission Journal on Quality and Patient Safety, Volume 31, Number 8 438-446(9), j 2005.
- Harris, Holmes, A.J Schwartz, and G. Regehr. "Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship." Adv Health Sci Educ Theory Practice: 2014.