Cold Feet” in-Training, the peer-reviewed online publication for medical students
There is a fine line between medicine and mortality: give too much and it can kill someone; give too little and even that might kill someone. We come to the hospital with the intention of saving lives, and anything that deviates from that goal is seen as a failure of the system or, sometimes, of ourselves. However, over time we learn that there is an in-between where we both try to preserve life, while embracing the idea of human mortality. And somehow, we have to find a balance between providing compassionate care and maintaining enough distance to have clear thought and action. Such experiences have not been too common in my training so far, but they have certainly left a lasting impression.
The patient came in with agonal breathing. The emergency medical services team had put him on oxygen before he arrived, but he appeared to be in very serious condition. The junior resident at the head of the bed, ready to intubate at the right time. Our superior took on the role of supervising the resuscitation.
He was immediately placed on high-flow oxygen, but we quickly learned that his code status had not been confirmed. The elder then called the patient’s family while continuing to take lifesaving measures – the next best step would be to intubate, but would that be within our patient’s wishes?
“I don’t want you to feel like you’ve made that decision; I want you to think what [your] dad would like…” the senior resident told our patient’s son.
Over and over, she repeated that phrase, hoping to reach consensus on how to handle this rapidly deteriorating patient. It was clear from the words we could hear over the phone that the patient’s son was in shock. His mother—the patient’s wife—had already postponed any decision-making.
“Okay, they don’t want a tube…” the eldest finally said.
Soon began the reversal of everything we had prepared for before: tubes, slides and oxygen were put away, leaving the patient panting with each labored breath. For a layman, this scene would have been shocking, but I had experienced this scenario before and was ready for the next steps. I knew what it meant to take a step back and accept reality – to provide enough analgesia to make the patient feel comfortable in their final moments. Brief glances with minimal eye contact would be exchanged between medical staff – an acknowledgment of the solemn but reassuring nature of the situation. Each of us would process the decision differently, recognizing the reality that life would not be preserved in this case. Although it was not what we hoped for, there was certainty in the end result: peace and less suffering.
But the speed with which everything was removed was somewhat alarming. I watched as the nurse silently put away tools, unplugged appliances, and cleaned the sink. I couldn’t do much other than wait with the rest of the team for the family to arrive. Still, I wanted to do something, really anything, to feel that I had made a contribution. As I was about to leave the glass room, I noticed that the patient’s feet were uncovered. I hesitantly pulled the cream-colored blanket over her dry, withered toes. I would have liked to know more about his story in addition to how he appeared to us that day. If only I could get a glimpse of what life had been like in his place.
Every 30 minutes that passed, I walked past the room to make sure he was still breathing and to see if the family had arrived. I knew the elder had alerted our front desk to the situation, but wanted to be reassured that our patient would receive a proper goodbye.
After about 180 agonizing minutes, a nurse alerted us that the patient’s monitors were showing asystole – a sign of dying. By then, the patient’s family had arrived and had been at his bedside for some time. I followed my eldest into the room. We all watched carefully as she listened to the patient’s chest while simultaneously checking her pulse.
“He passed,” she said.
“Dad passed away,” she repeated, looking up at the family after being invited a second time.
We slowly withdrew from the room to give the family some privacy. Although we were unable to save this patient, I was reminded that sometimes doing nothing is actually doing everything. We had offered him a comfortable respite to make the transition from this life to the next. It was the best we could do based on the son’s perception of his personal preferences. All of our actions were aimed at honoring those wishes and I felt proud to have been a part of that process, even if it just meant covering his feet before his family arrived.
Contributing author
Cleveland Clinic Lerner College of Medicine
Joan is a final year medical student at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University in Cleveland, OH (class of 2022). In 2013, she graduated from Duke University with a Bachelor of Science in Neuroscience. In 2016, she earned her second degree from Duke, a Master of Science in Biomedical Science. She loves to travel, explore nature and take candid photos of her loved ones in her spare time. After graduating from medical school, Joan would like to pursue a career in emergency medicine.
