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Medical Education, Medicine and Society, SMS Unplugged

The woman in the elevator: dealing with death in medical training

The woman in the elevator: dealing with death in medical training

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

flowersAlmost every patient I meet gives me the gift and curse of forcing me to confront a new side of my own vulnerability. I see new ways to die, new ways to suffer, new kinds of setbacks or losses. Of course, very little of this knowledge is technically new: My mother taught me that everyone dies, life isn’t fair, and so on. But since starting clinical training, what is new is the intimacy with which I live that knowledge.

On my neurology rotation, I was sent to examine a little boy in the ICU who had become unresponsive. I will never forget what I saw when I lifted his eyelids. His right pupil was rapidly changing shape from lumpy oval, to diamond, to a slit like a cat’s eye.

I alerted my attending, who somberly explained that that the boy’s brain was probably herniating – in other words, it was under so much pressure that it was being pushed into places it shouldn’t go. A few minutes later, a CT scan showed massive bleeding in his brain. The neurosurgeons were called, but determined they couldn’t save his life. As we left, a curtain was pulled in front of the room.

A few minutes later, already back to work in other parts of the hospital, my team stepped into an elevator. Before the door could close, a young woman ran in behind us. As the elevator ascended, she sunk to the ground and wailed, “Am I going to lose my baby? Please don’t let me lose my baby.” When the doors opened, she sprinted toward the ICU. With horror, I realized the woman was my patient’s mother. Her baby was already gone.

The next morning was a gorgeous Saturday. I had the weekend off so I put on my grungiest clothes and headed to my community garden plot, determined to separate myself from the week’s experiences. Weeds had crept in during a few especially difficult clinical months. I placed a shovel in the dirt, put all my weight on it – and it didn’t budge. I tried again, but the soil wouldn’t yield. I discarded the shovel and reached to pull a huge weed. The dead branches crinkled off in my hand, roots still entrenched in the hard, dry California earth. I sat down among the weeds, defeated, face in my hands.

A woman working another plot – a fellow student gardener I had never met – walked over and asked, “Are you okay?”

“I’m just not strong enough to do this. I should give up my plot.”

“I’ll help you clean it up,” she offered.

“Thanks… Sorry… I’ve just had a bad week.”

“Lots of final exams?”

“No. But I watched a little kid die yesterday.”

My new friend didn’t miss a beat. She knelt down, gave me a hug and said, “You are strong enough. Let’s get your garden cleaned up.”

I believed her, and kept gardening. I proudly told myself I had found an outlet to successfully cope and put the horrible experience behind me.

But it turns out things like watching that child die aren’t processed and compartmentalized so neatly, and can come back to haunt even the best and most personal times. A few months later, on the night before my daughter was born, my husband and I arrived at the hospital full of excitement, and stepped onto the elevator on our way to Labor and Delivery. But as the doors slid shut, I couldn’t suppress the mental image of the last time I rode that same elevator: a desperate young woman on her knees, repeating “Am I going to lose my baby?” For the thousandth time in medical school, I knew the fragility of my own blessings.

I have come to believe that coping doesn’t mean finding a way to separate “personal” life from “professional” experiences. There is no healthy coping mechanism that will let me walk away from experiences like this unaffected. Instead, I just keep telling stories like this one over and over – to myself, my friends and family, and now you – hoping that in the retellings I will find some meaning, some wisdom, some gratitude, or some peace.

Jennifer DeCoste-Lopez is a final-year Stanford medical student applying to residency in Pediatrics this year. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

5 Responses to “ The woman in the elevator: dealing with death in medical training ”

  1. N. Wood Says:

    What a wonderful ‘blog’ especially from a hospital that has on their staff one of the greatest doctors; a person who guided me through the process of healing physically with the same kind of compassion. He was not at Stanford during that time but I am sure you, Jennifer, will reap the benefit of his caring, skillful, knowledgeable sense of academia…

  2. Russie Says:

    Thank you. Sometimes as a patient we forget how difficult it is for the doctor, for you. I only have to hear my diagnosis once. You have to repeat those awful words over and over to so many. I live with my disease, you live with the diseases of hundreds of people. Thank you for what you do from all of us patients. We couldn’t make it without you.

  3. Allison Truong Says:

    This was beautiful and brought tears to my eyes. It really brings out the true emotions that are inside us all as medical professionals, when we are deeply affected by our patients. I am conflicted everyday as I try to find better ways to cope with my emotions so that I can help my patients cope with theirs. Its a reward and blessing to be rewarded with this humbling responsibility, to take care of a person, their families, and their loved ones. Thanks for sharing Jennifer.

  4. Nicole Bergeron Says:

    Jennifer thanks for sharing these painful stories and insights. As a parent of a child resuscitated at birth at LPCH and then whisked to the NICU, it is amazing how haunting all of these images remain. This daughter of mine is now a thriving pre-teen, baller, actor…but the years at Packard cast a long shadow and took tread off my tires. Even as an infant she would remark and grimace when she saw the trees on Welch Road, “I don’t like these trees Mommy,” it was her way of noting that we were almost at the hospital. Still one of the simplest acts of kindness resonates with me to this day: some Stanford/LPCH–scrub wearing person saw us in the belly of the beast as we walked around trying to generate sweat on my 2 year old’s arm for a CF test…he stopped us in the hall and bent down and said, “Aren’t you the most adorable little girl!” He smiled, left and I never saw him again but that interaction got me through that day. I will never forget the combination of excellent care and compassion we got at Packard. Thanks for your part in it.

  5. Jai Madhok Says:

    Such a beautiful piece Jenn! This piece captures the essence of why it is so hard to describe the impact that patients can have on someone. Diagnoses and names fade away but the look in someone’s eyes and the moments one shares with patients and their families can’t be forgotten.

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