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The Inevitable Rendezvous With Mortality

Samuel, Nardin

doi: 10.1097/ACM.0000000000002154
Teaching and Learning Moments
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N. Samuel is a fourth-year MD/PhD student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; e-mail: nardin.samuel@mail.utoronto.ca.

Author’s Note: The name and identifying information in this essay have been changed to protect the identity of the individuals described.

An Academic Medicine Podcast episode featuring this article is available through iTunes.

His condition was deteriorating rapidly. Mr. James was in his late 50s and had end-stage liver disease as a result of chronic alcohol use. Throughout the admission, he had been very confused and disoriented, or encephalopathic, which was a harbinger that the end was on the horizon.

One day, when Mr. James was more lucid, I was tasked with speaking to him about his wishes for resuscitation. Although this conversation is a routine occurrence on any internal medicine rotation, it would be my first time independently having a “code status” discussion with a patient. I approached his bed at the far end of a dimly lit room with the curtains drawn. He lay there motionless. The poignant yellow hue of his skin spelled out his diagnosis. There was a middle-aged woman at his bedside, but judging by her scrubs, she was a hospital employee who was there to monitor him, not a friend or family member.

His arms were crossed, his eyes closed. “Mr. James,” I began. “Mr. James, I am here from the medical team to speak with you.” I spoke with him about his understanding of his prognosis and his views regarding resuscitation if and when he might need it. Not unexpectedly, Mr. James did not desire any form of advanced lifesaving maneuvers. I was thankful that the hospital sitter was there to witness the conversation and documented his wishes in his chart. Yet while Mr. James seemed to understand his precarious health status, I am not sure that I processed his dire situation, even amidst these discussions. Unbeknownst to me, this conversation would be the last time I would see Mr. James.

The following week, as we were running through our list of patients one morning, I noticed that we skipped over Mr. James, even though his name was still there. I learned from my classmate who was on-call the night before that Mr. James had been found lifeless without vital signs and pronounced dead at 4:00 AM. In the early hours of the morning, he had died, without a single family member or friend around. Even the person listed as his emergency contact had been unreachable. I lamented how, prior to that weekend, Mr. James had existed on this earth. We had had a conversation. Yes, he had been ill, but he was still a living, breathing human being. Yet today, the only remaining vestiges of him were mere ink markings on a page, which we had quickly skipped over as we had forged on with the next patient on our list.

Mr. James tragically departed from the world alone. It was my first time experiencing a patient’s death, and I needed time alone to reflect on it. I knew this rendezvous with mortality was inevitable and that it certainly would be only the first of many such experiences throughout my medical career.

I stepped outside the confines of the hospital for a breath of fresh air. I needed to gather myself. This experience reminded me that grieving and loss are inescapable dimensions of the human experience, yet they are often a silent undertone in the practice of medicine. As current trainees and future physicians, there are undoubtedly times when we need to push forward at full speed. However, there are also times, albeit brief ones, when we need to take a few moments to gather ourselves and our thoughts, particularly when we are confronted with situations such as the loss of the very essence of human existence that we so vehemently work to preserve.

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Acknowledgments:

The author thanks Dr. Baruch Jakubovic for helpful input and guidance on this essay and for encouragement and mentorship as the chief medical resident.

© 2018 by the Association of American Medical Colleges