The Human Element of Medicine (A Neophyte’s Perspective)

“Let the medical student do the compressions.”

I slid my way through the team of nurses, respiratory technicians and residents to begin doing compressions on the patient. I had practiced CPR hundreds of times before. I’ve taught countless classes during my 3 years as an instructor at UCLA. I should be ready for this. Hoping to desensitize myself to the situation, I tried to imagine a mannequin’s off-white plastic face and blue styrofoam chest. But as my hands touched his chest, I felt the warmth of his body permeate through my gloves and instantly the reality of the situation snapped in. This was a real human being. My practice or training didn’t prepare me for that.

I hadn’t met this patient when he was alive. I didn’t know why his heart failed. I only had a cursory skim at his chart as to why he was in the emergency room. He was a cocaine and methamphetamine addict coming in with an episode of low blood sugar. His chart didn’t even seem worth reviewing at the time. I was supposed to be in the emergency department to learn about interesting or unique medical conditions and cases; his was neither. Yet here I was, learning about a side of medicine I didn’t expect.

I could feel sweat accumulate underneath my light blue scrubs. My shoulders and triceps burned. The compressions were continuous, only pausing briefly to check for pulses and vital signs. I swapped out with a nurse and a fellow medical student. The patient began to cough up blood from the trauma we caused by throwing our weight on his breastbone. After 20 minutes his vitals began to come back and I breathed a sigh of relief. I smiled, proud of the work I had done. I helped to bring him back. I was doing something good. Glancing around, I didn’t see any other smiles on the faces of the medical team. I looked at his plummeting heart rate and I was back on his chest within minutes. My smile quickly faded.

I kept going. I didn’t want him to die. I looked at his face: his eyes were rolled into the back of his head, his unkempt beard stained with dried blood.

One of the residents shouted,

“Any family or friends here yet?”

The question was met with silence and a shaking head. The attending physician proceeded to tell us if he flatlined one more time we were going to call it.

I stared at the attending. I wanted to keep going. I looked back at the patient. I kept going.

“Stop. We’re calling it.”

My hands were still on his chest. My breathing was still labored. I felt a gentle pat on my back.

“You did a good job.”

A good job? The patient died. We failed. The room was numbingly void of emotion. Everyone finished up protocol and left the room. I wanted to scream “someone just died! How can you not feel anything or say anything?” But instead I slumped back to my work station.

“Jeremy, there’s another patient we need to see.”

I got up and quickly followed.

It’s been a week since he died. It was the first time I had seen someone die in front of me. Right now, I still struggle processing what happened. Why does it still bother me? Why do I feel as if there is no sense of closure with his death? I finished a year of medical school and yet I was completely unprepared. Death isn’t a comfortable topic, but it’s inescapable. Death is the one guarantee in a life full of uncertainties.

“Are you scared of death?”

My dad only briefly mused the question between the bites of dinner.

“No, not really.”

We both laughed and took sips of wine from our glasses. It was strange that I had this conversation only a few weeks prior to that night at the ER. I told my dad that I felt the same way he did. It was a summer night when my 13 year old self stared at the ceiling and thought about death. I grew up believing in heaven and hell after death, but that night I pondered about the possibility of nothingness. An afterlife where I was not only unable to feel, but also unaware that I was unable to feel. There was only dark emptiness. I remember closing my eyes and holding my breath while I laid there. I let the silence settle in. The silence crawled into fear: a fear of loneliness, a fear of the unknown, a fear of permanence. But, I remembered in death that I wouldn’t exist, I wouldn’t think, I wouldn’t feel fear. The fear drifted into calm.

As I closed the eyes of the dead patient it felt eerily similar to closing the chapter of a book. His story was over. I played my part in his life and his in mine. I felt unsatisfied. A question tunneled its way out from the back of my mind, “what then does life mean?”

What does life mean? I thought I had it all figured out my senior of college; life was about having fun with friends, doing something to help others and enjoying what you had. However, something felt naive and limited about that definition of life. There was no universality to it. People from different upbringings will most likely have different meanings of life. Meaning is subjective and I have to try my best to understand each person’s meaning in life — even though I have yet to discover my own.

As I walked in to meet my next patient, I was surprised to meet such a genuinely nice patient in the ER. We bonded immediately. I listened to his stories about his Pomeranians, the Vietnam war, and his wife and daughter. My mom always told me you could spot a good person by the gleam in their eyes. Although he was paraplegic and his body no longer moved much, his eyes were still full of understanding and radiance. Throughout my shift, I would pop in his room just to talk with him. He was always polite and he radiated such warmth with his words. However, by the end of my shift, the attending went in with me to tell him that he would need to undergo surgery to resect a portion of his bowel. The patient smiled softly and thanked us for our time. The attending left the room, but I lingered behind. The patient told me he knew that his chances of survival after the surgery were low.

“Jeremy, listen, don’t be sad. I’m not sad, nor am I scared of dying. I believe that there will be a place after this life. Somewhere beautiful where we can meet each other again and I look forward to seeing you there.”

I could only nod in agreement. I too longed to believe in that place. Shaking his hand for the last time, I wished him farewell. I don’t know what exists after death. Maybe it’s nothing. Maybe it’s paradise. Maybe it’s something entirely different.

I don’t really have any answers right now, and I probably never will. It’s frustrating as a medical student because you’re trained to look for one right answer out of A, B, C, D or E. But I’m starting to realize that maybe there isn’t always a clear answer. I don’t want to limit myself to thinking that there is. I want to be open in order to learn, to connect, and to help my patients. But to keep myself open to interacting with patients, I need to be vulnerable and with vulnerability there will be inevitable pain. There’s a human element to medicine, and it’s the toughest test medical school has given me yet.