The first time I witnessed someone die in front of me will stay with me for a long time. I was only eighteen, early in my EMT experience, and transporting a patient home from the hospital while my colleague drove the ambulance. The patient was an eighty-seven-year-old man, and although I do not remember the exact diagnosis, I knew he was on hospice, nonverbal, and expected to pass soon. He had already signed DNR/DNI orders and wanted to be discharged to be with his family to spend his last days with them. My job was to check the patient’s vitals every few minutes in the back. I would talk to him reassuringly, take his blood pressure and pulse, and sometimes he would let out a weak groan. It was a fairly short drive, too—around twenty minutes.
Around five minutes before the destination, his pulse started feeling weak. I thought I was just checking it wrong, so I placed a little more pressure on his radial artery. It was barely there and slow. I checked a minute later and felt nothing at all. His respirations had already been too shallow to notice, but now I could definitely not see his chest rise and fall. Panic started setting in—am I supposed to start CPR? Oh, wait, he is DNR. I told my partner, and he replied, “Uh … OK, hold on, we are almost there, and I will check.” It felt so wrong to do nothing. I just stared at his closed eyelids and imagined he was holding on, because surely some life was still there. Surely his final moments were not with some random stranger like me.
Once we got there, brought him in with the stretcher, and slid him into his special bed they had set up in the living room, we were surrounded by his wife, two sons, and his home nurse. The nurse checked his vitals and pronounced his “official” time of death at that time. It felt so matter-of-fact. His wife started crying and hugging his body, saying: “You just wanted to get home, I know. You can go peacefully. We’ll be OK.” I started tearing up, and my colleague asked me to excuse myself as he collected the family’s signatures that confirmed we dropped him off. The iPad app we used for documentation seemed so silly in the wife’s face, even though she did not seem upset about it. My much more experienced and older colleague took the time to stay and comfort them, which I admired but was ashamed that I had not had more control of my emotions. I sat in the truck and wondered what were the “right words” he was saying to them, and I thought of the logistical work of planning a funeral, paying the medical bills, and removing the special hospice bed that now fell on the family.
As a current third-year medical student seven years after this experience, I still wonder how I would react if it happened now. The challenge lies in embracing my sensitivity that allows me to be compassionate and feel other people’s pain so strongly while still having boundaries to support them in their time of need in a professional way. I have not directly seen another death in the hospital yet, but I can tell that clinical rotations have already numbed my human response to such events simply by hearing poor prognoses so frequently. I hope I will someday find a balance between that empathy and strength, and perhaps even recognize that the former does not necessarily mean the lack of the latter.
Ruchika Moturi is a medical student.
