Consultant. 2013;53(8):572

“The boast of heraldry, the pomp of pow’r,
And all that beauty, all that wealth e’er gave,
Awaits alike th’inevitable hour.
The paths of glory lead but to the grave.”
                                                               ~ Thomas Gray

The Medical Student

The EMT pushed the gurney into the emergency room, rattling off key information. A 23-year-old male—unrestrained back seat passenger—presents with extensive injuries, lacerations, and head trauma secondary to a MVA. The patient has a weak and thready pulse with shallow respirations and poor response to stimuli. He lost consciousness at the scene and did not regain it en route.

I may not have been there, but I know how the scene in the trauma bay unfolded. Surgeons and ER doctors rushed in, gowning and gloving themselves as they rapidly fired off orders. The patient’s pulse and blood pressure were recorded, an IV was started, and the OR was put on standby. In that instance, my friend was reduced to a set of numbers, readings, injuries and conditions. His life—the person he was and what he meant to those close to him—was simply not relevant.

In the ER, one of the residents was probably crushing my friend’s rib cage as he performed CPR. Another resident was likely putting a trache tube down his throat, cursing as it didn’t go in and digging the Mack laryngoscope in deeper. The person running the trauma was standing at the foot of the bed, calling out for the trauma OR to be prepped and asking the hapless medical student to feel for a femoral pulse. And the medical student was probably in awe, albeit slightly scared, at his first hands-on trauma experience.

When they did a thoracotomy, cutting my friend’s chest wide open in a last desperate attempt to save his life, that same medical student was likely slack-jawed behind his facemask. And when my beautiful friend died, that same medical student probably walked away focused only on what he had just seen, memorizing the procedures and replaying his mistakes. How do I know that he likely didn’t spare a second thought on the patient who just died on the ER table in front of him? Because as a medical student myself, I never did.

The Friends and Family

I first heard about my friend’s death from a mutual friend who lived next door to the grieving parents. I remember reading the text as I was walking home from a party, convinced this was a twisted joke. It took me a long time to process through all the emotions and regrets that follow when you lose a friend of nearly 12 years. I was still in that state of shock when I went to the funeral.

This is not my first time seeing death. In fact, I met my own human cadaver on the first day of medical school. I’ve worked in the ED and seen many patients with severe injuries. I too was amazed the first time I had to slice open a patient’s chest or search for a bullet inside the body of a patient with a gunshot wound.

Yet, as I stood at my friend’s funeral, I found myself questioning my own ethics. As a medical student, the grislier the incoming injury, the more excited I found myself. Was I wrong to objectify my patients in the service of learning? I struggle to bridge the dichotomy: In the ED, traumas were fun and fascinating, but when the tables turned and my friend was the patient, trauma was heart-wrenching. And as I stood at my friend’s funeral and shared stories of our time together, I thought of all the forgotten patients who I treated in the ER. And in that moment, I realized I hated myself and who I had become.

Learning to Compartmentalize

I began to feel like each time I had taken a case, I had systematically ignored the patient a story, a life, and an existence that was so much more than a set of vitals and a 3-line synopsis. I realized that I had left the human element out of my work. In doing this, I had reduced my patients to a series of vitals and a set of conditions to be fixed. And even more so, I remembered them only for the education they gave me—i.e., the first IV I inserted, the first patient I practiced CPR on, etc. It was callous.

But, I also came to the realization that, in those moments in the trauma bay, the meaning of a life has to be secondary to the immediate necessity to save a life. If we can save the body, then we can give the whole person a second chance.

For the doctors who work in trauma day after day, death is another member of the team. It often times is a conscious decision to stay emotionally distant from every person you treat. And, as a medical student, isn’t it good that we look at trauma as exciting, for that is what drives our interest in learning how to diagnose and treat serious cases? In some ways, objectification is a necessary evil to ensure the survival of medical knowledge.

I remember the agony I went through losing my friend and recognize that it is a pain that I cannot tolerate daily. Distancing myself is a way of self-preservation. So, I do not feel guilty when I reduce my patient’s lives to a measly 3 lines. But, I do the best I can to make what is one of the worst moments of his or her life a little more comfortable, a little better. I hope someone did that for my friend.