A Wall

A 25 year-old man is rushed to the emergency department in a comatose state after being brought in by his friends from a party. The details are vague, but respiration was minimal and the patient was intubated, brought to the ICU, and admitted to the hospital while further workup was to be completed. Unfortunately, the patient was never brought back to consciousness. Despite the best efforts of the hospital and physicians within, the young man passed away, never regaining his mental function. Given the situation involving the young man’s admission to the hospital, an autopsy was to be completed as part of a Coroner’s investigation.

That is where I came in.

As a premedical student, between my undergraduate education and starting medical school, I spent about two years in various roles: a year and a half of which was acting as a Forensic Autopsy Technician. Needless to say, I saw my fair share of death ranging from myocardial infarctions to homicide, from suicide to car crashes. However, as the technician, I was typically insulated from interaction with the surviving family members. It was more often the Deputy Coroners who were there to console them in 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 that would be developed while I was in medical school. Yet, this young man stands out as my first foray into caring for a whole patient, or more specifically, those who are left once the patient is gone.

The young man was Islamic, 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 all culminating in the sorrow of losing such a loved son. I stayed long that evening to attempt to remove all traces that an autopsy was done, or if not, that it appeared neat and 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 would be arriving. I was alone there to lead the father to his son, to respectfully roll the body out, and be there to offer condolences. In shock, he asked for the drape to be removed before moving his son.

A wail for 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 telling myself. It became a crash course in grief: supporting a person in their moment of agony and bereavement. An instantaneous lesson in balancing verbal condolences with the power of a silent hand on the shoulder of one who felt as though they were alone. We sat there together in silence, the father not yet ready to speak, and myself 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 was likely only a few minutes, the father regained his composure, turned 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. We exchanged 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. Their own stories and tears to share. Ultimately, they all left with their little brother, their son, in preparation for the services he was to have before returning to the earth.

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 about 3 years later, and 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, observing the physician tell a patient there are no more options for their Stage IV cancer left and left alone with the patient immediately after. I’ve now taken several doctoring courses regarding how to console patients, how to discuss dying and goals of care, and how to be resilient within a profession charged with emotion. All of these have been critical to my development, but none have had more impact then dealing with a family who just lost the youngest member of the family or a patient who is now realizing they have months to live.

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

 It is frightening.

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Jonathan Warren

Jon Warren

Third year medical student soon to be Emergency Medicine resident. Photographer. Hiker. WikEM editor. Netflix watcher. Dog enthusiast.

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