To the Editor:
In the medical intensive care unit (MICU), death is simultaneously everywhere and nowhere. When patients die, they disappear from our census, and their rooms are quickly repopulated by other critically ill patients. MICU patients who die are ostensibly forgotten—not today, though. Today is Grieving Rounds. During these once-monthly Grieving Rounds, chaplains visit the MICU to help us reflect upon patients who have passed away. Some residents choose to skip the 8 am session, opting to get an extra arterial blood gas sample or grab coffee before “real” rounds begin. My patients are stable and my body is precaffeinated, though, so I assemble with a few other residents in the conference room where the chaplains are waiting.
The chaplains identify this half hour as a safe space and then invite us to share stories about our now-deceased patients. The postcall resident speaks up almost immediately: “Is it okay if I talk about someone who didn’t actually die?” The chaplains nod, and the resident tells us a story from last night: A patient on three vasopressors by 2 am, a patient whose family the resident had called to the bedside by 3 am, a patient whom the resident had fully expected to die by 4 am. Except he hadn’t. The patient had somehow turned a corner and was now nearly off vasopressors. “I’m really glad he’s doing better, but I feel like I’ve failed. His family trusted me so much, but I was so sure he’d die that I had almost already advanced his code status. I was so completely wrong—and I lied to his family.”
This story took place almost two years ago, yet the rawness in the resident’s voice haunts me to this day. I have taken the chaplains’ thoughtful responses to heart: to accept uncertainty and to embrace miracles however they happen. But no Grieving Rounds since that morning—and I have attended many—have ever been as poignant. Why? Because emotional strength during residency is more than acknowledging that our patients are human and thereby mortal. Physician resilience necessitates that we acknowledge our own humanity—including the facts that we may be wrong, that we may mislead others when we are wrong, and that we may be prideful until our wrongness is discovered. Grieving Rounds are powerful tools to accomplish this goal, but only once we acknowledge that death is not the only thing we grieve.
Rahul Banerjee, MD
Third-year resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; [email protected]; ORCID ID: http://orcid.org/0000-0003-3781-5441.