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Narrative Medicine

First Taste of Grief

Warren, Jon

doi: 10.1097/01.EEM.0000558084.88483.ef
Narrative Medicine

Mr. Warrenis a third-year medical student in Los Angeles and a soon-to-be emergency medicine resident. He is a contributor to the Physician Grind (www.physiciangrind.com), a storytelling forum started by Zahir Basrai, MD, where this article was originally published. Connect with the Physician Grind on Facebook (https://www.facebook.com/numosemed/) and Twitter @nuMosemed, and listen to the Physician Grind @ EMN podcast athttp://bit.ly/PhysGrindEMN.

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A 25-year-old man was rushed to the emergency department in a comatose state by his friends after being at a party. The details were vague, but his respiration was minimal. The patient was intubated and brought to the ICU, but unfortunately, he never regained consciousness.

Given the circumstances, an autopsy was to be completed as part of the coroner's investigation. That is where I came in.

During the period after graduating from college and starting medical school, I spent about two years in various roles. For most of that, I was a forensic autopsy technician. Needless to say, I saw my fair share of death, ranging from myocardial infarctions to homicide, from suicides to car crashes. As the technician, however, I was typically insulated from interactions with the surviving family members. It was more often the deputy coroners who consoled them during one of the worst times of their life.

I had no experience in providing a much-needed foundation for people during a moment of crisis, and figured that it would be a skill I would learn in medical school. This young man was my first foray into caring for the whole patient, or more specifically, those who are left once the patient is gone.

The young man was Muslim, and, in their culture, burials are to be done within 24 hours of death. Our office was understanding and expedited the paperwork to complete the autopsy as soon as possible. I was told to prepare the man for retrieval by his father the next morning. As I stood there, meticulously cleaning any blood that may have remained from the autopsy, I could only think of the emotional turmoil the family must be experiencing. Hurt. Stress. Pain. Everything culminating in the sorrow of losing a beloved son. I stayed late that evening to remove all traces that an autopsy had been done, and to make sure he appeared acceptable for viewing despite the all-too-telling Y-incision.

I decided to get in early the next morning. I knew it was going to be a busy day and figured I could start finishing some paperwork to move things along. Little did I know that I would be the only one in the office when the father and brothers of the young man arrived. I was alone there to lead the father to his son, respectfully roll the body out, and offer condolences. In shock, he asked for the drape to be removed before moving his son.

A wail of pure pain and grief echoed within the walls of the morgue, forever seared into my memory. I wasn't sure what to do. I had never been in a situation like this. “I'm not trained for this,” I kept saying to myself. It became a crash course in grief, supporting a person in his moment of agony and bereavement. An instantaneous lesson in balancing verbal condolences with the power of a silent hand on the shoulder. We sat there together in silence, the father not yet ready to speak and me knowing that I should not intrude into his thoughts. Nothing I could say would return his son to him. After what seemed like an eternity, though it was likely only a few minutes, the father regained his composure and realized for what I think was the first time that I had been there with him the entire time.

He thanked me. It shocked me. I should be thanking him. In this instance, I learned more than any doctoring course could teach me about dealing with family members understanding the heartache of death. He told me stories about the young man's life, his cherished memories and accomplishments in life, and then I met all the brothers who had come as well, with their own stories and tears to share.

Work returned to normal. There was no fanfare, no debriefing, no discussion of what had transpired that morning. I needed to regain my emotional composure to continue to operate at the highest standard, and it felt like whiplash.

Fast forward to three years later, I'm now in my third year of medical school with aspirations of emergency medicine on my mind. I've spent time in an oncology clinic where a physician left me alone with a patient immediately after telling him there were no more options for his stage IV cancer. I've now taken several doctoring courses about how to console patients, how to discuss dying and goals of care, and how to be resilient within a profession charged with emotions. All of these have been critical to my development, but none has had more impact than dealing with a family who just lost their youngest member or a patient who now realized he only has months to live.

I feel as though the first time a medical student finds himself in this situation, it is jarring, shocking, and unexpected. Standardized patients, though fantastic actors, will never equate with the raw emotions of the true situation. You understand there is grief. You understand there is loss. You understand more than a grade is at stake.

It is frightening.

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