At the beginning of third year, there were numerous things that I was excited for, and an equal number of things that I was nervous for. One of the items on my "nervous" list included the experience of my first patient death. I wondered how I would handle it and what the circumstances would be. But during September of my third year, I experienced death in a way that I didn’t expect to during that year. I guess I had envisioned my first death of medical school to be a patient I was caring for who was an older individual, someone who had a laundry list of chronic conditions and in the end succumbed to an eventual death after a fulfilling and joyful life. But instead, I experienced death through the birth of a 19-week-old baby and then a week after that through someone who was not a patient but was my own grandmother.
The first death was while I was on the L&D service. The mother of the baby had presented with abdominal cramping and bleeding and was found to have a presenting fetal limb in the vaginal canal. She was in the process of a spontaneous abortion. The delivery was painful to partake in, starting with first checking to detect a fetal heartbeat with ultrasound. It was heartbreaking to relay to the mother that there was no detectable heartbeat. After delivery of the baby, it was again heartbreaking to see the mother holding her child, giving him a name, and handling the difficult situation with such beauty and grace. When pre-rounding on this patient the next morning, one of her immediate questions was when she could hold her son again, because a nurse had placed her child in a refrigerator for preservation. A heartbreaking question that so greatly differed from the other joyful moments on the L&D floor.
Just about a week later, I received a text in our family group message from my cousin saying that abuela was in the hospital again and that they weren’t sure what was happening, but it was something serious. After asking more questions, we found out she had had an unwitnessed cardiac arrest; now she was unresponsive and intubated in the ICU, undergoing the hypothermia protocol. After my other family members were able to make it to the hospital the next day, my mom called and told me that I needed to get on the next flight out to LA. After making it to the hospital, we had a family meeting with the intensivist who was caring for my grandmother. At this meeting, the physician informed my family that she was brain dead and that we needed to make the decision to pursue a trach and long-term placement or to withdraw care. Together, we as a family decided to cease respiratory support with removal of the ventilator. Just 27 minutes after removing the ET tube, my grandmother passed away, with all five of her children and three of her grandchildren present around her beside.
Two deaths in two weeks. These were not the ways that I thought I would experience death during my third-year clerkships. I never thought that I would experience the delivery of a child who was under the age qualifying for resuscitation in the NICU, and I never thought that the death would occur in one of my own family members. Looking back on these situations, I find it ironic how they couldn’t be more different. One story belonged to someone who was not yet fully formed in the womb, someone who had not yet had a chance to walk, talk, or experience life. The other death involved a person who had made it to the age of 80 and had lived a life full of experiences, filled with both hardships and joys. Seeing death at both ends of the spectrum was not the way that I thought my first experiences with death would occur during third year. And while I don’t understand why this baby was not given the chance to experience life, nor do I understand why my grandmother was taken so suddenly, I have learned so much from seeing life come full circle for these two individuals.