Shaking hands with death

My clinical experience through MIT
Sept 2020
Nicolas
M.
Harvard-MIT Health Sciences and Technology

When I entered the room, I took a few moments to look around. The room was lit by a warm, orange glimmer sneaking through the window blinds, announcing the end of another beautiful summer afternoon. I took one step forward as the nurse pulled the bed curtain closed behind us. The patient was an old man. His face looked calm, almost peaceful despite being on a ventilator and hooked to multiple IV lines. The digital sound of his heartbeat was echoing in the room, slow and regular. I naively thought he was asleep. The loud voice of the attending physician promptly brought me back to reality:

“Still no cortical activity, huh?”

The question was directed at the resident standing next to me, but still, I froze.

I had been in Mount Auburn Hospital for a few weeks. I was finishing up a six-week clinical rotation as part of my PhD program through the Health Sciences and Technology (HST) department. My role there––and that of others in my cohort––was akin to what can be expected of a first-year medical intern. Everyday, each of us cared for one or two patients at a time, visiting them typically once in the morning and once in the afternoon to collect their medical histories and perform basic physical examinations. We had to gather all the necessary information before reporting back to the attending physician who was ultimately responsible for making the final calls on orders and meds to be placed for the following day.

At times, I must say, this entire experience felt much like being dropped in a completely foreign country. I had been struggling to learn the words, the acronyms, the associations of thoughts, the rhythms of conversations, as well as the conventions as to what should be explicit and what should remain implicit. So you can easily imagine my reaction when, in that moment, in that room, someone had finally used a term I was intimately familiar with.

“Cortical activity” is indeed what I study in my research, although clearly not in the same context. I know from experience that it can be hard to find good signals in the brain, and that it is sometimes equally difficult to find any signal. So I found myself stupidly wondering: what if they aren’t looking hard enough? What if I could find his cortical activity? But once again, I was being too naive. The patient had been in a coma for the past few weeks, and his chances of recovery were growing slimmer each day. There was nothing that we, and certainly I, could do.

Facing my own helplessness wasn't the only challenge I had to endure during this clinical rotation. The hardest part for me was to step out of patients’ rooms after hearing what they had to say, after looking them in the eye while they described their pain, knowing that I would have to move on with my day shortly after. That I’d fall right back into the routine, and reset my mind for the next patient. That I would eventually forget the patient. Forgetting always felt like letting them down. People sometimes ask whether a tree that falls when nobody is around to hear it makes a sound or not. Likewise, I wonder what happens if someone passes when nobody is here to remember them.

I have now stepped out of my patients’ rooms, and will likely never go back. Why? Perhaps out of fear of facing my own helplessness again, and to let more of them down. Thinking back on this entire experience at Mount Auburn, what I see in my head is some sort of blob, made of each person I encountered, examined, or simply observed. Faces, names, room numbers, all of that is long gone, anonymized by my frankly overwhelmed mind. But despite the fuzziness, I can sense how this experience has changed me. I had seen people around me pass away from illnesses and accidents in the past. Yet, this experience at Mount Auburn was the first time in my life that I truly acknowledged the reality that, ultimately, we are all meant to go.