Learn from the Nurses

I remember the first patient I lost in medicine. I remember his name, his smile, and the minute I realized he was gone.


He was the first patient I ever admitted to the hospital. It was during my first month as a third-year medical student. I was on inpatient Internal Medicine wards and it was my first night on call. My supervising resident assigned me to an intern and instructed me to go wherever he went. I followed him to the ER where my patient was in heart failure.


He was an elderly man who had undergone a recent orthopedic surgery and found himself struggling to breathe. He needed a tune up so to speak, and we admitted him to the hospital to help treat his heart.


He was ornery, witty, and irritated. He was a farmer. He was tough and found himself completely vulnerable in a hospital gown wearing oxygen and having to speak to a medical student through pursed lips – me. He looked at me with wary eyes, as he answered a million questions I asked him while trying to hide that I was in fact reading my pocket guide for med students on  “how to take a history and physical”.


I learned as much as I could about him. He reminded me of my grandpa, and I became very attached to him. Every few days he seemed to get a little better, but then he would have another complication or set back. He was still very alert and I could tell he liked talking to me as much as I did him.


Every day I would arrive at the hospital around 6 am and check in on him first. It was my job to “present him” on rounds with my team, where I would give an update on his progress and listen to my attending physician’s feedback on his care plan.


He was very much “my” patient.


One day I arrived early to see him and when I walked in, his bed was empty.


I stopped. I turned around and made sure I was in the right room.


There was an empty bed with clean linens where he should have been.


I quickly ran outside and paged my supervising resident. While I sat on the phone at the busy nurse’s station in the midst of the hustle and bustle, he told me my patient had suffered a cardiac arrest in the night and passed away.


I was crushed. He was gone.


As sick as he was, I never thought he would die.


I wanted to scream. Why did no one call me? Didn’t anyone care? I looked around the unit, and people were coming and going. Alarms were beeping. Medicine carts were being rolled down the hallway. Breakfast trays in and out. Nurses were answering phones and doctors were sitting at computers and writing down labs and test results on papers they would stick in their pockets to report on later.


I just sat there.


I must have looked lost, because right then one of the nurses, Mike, came into view, and said “Hey Sasha, everything alright?”


Mike had treated me with respect from the minute he had met me. Despite coming in contact with hundreds of students, he knew my name and helped me find things, order things, and do things I had no idea how to do from my first day of clinical medicine. I watched how he treated patients and I modeled my behavior after him in the first few weeks of my clinical career.


He had been my patient’s nurse several times over the last few weeks. I told him the news, trying not to let my emotions show. Mike stopped in the middle of the busiest time of a floor nurse’s shift, and talked to me. He told me it was normal to feel what I was feeling. He assured me we had taken great care of our patient. He asked me if he could get me anything. 


I thanked him and went to see the next patient.


That is the greatest and the hardest thing about medicine. There is always the next patient waiting for you. It helps take your mind off the reality of death, but it also makes it difficult to grieve.


Over the next few weeks when I would run into Mike, he would ask me if I was okay. I figured he must have mentioned it to the charge nurse, because she stopped me one day and told me what a good job I had done treating our patient. She said she noticed how much time I had spent talking with him, and that trait would make me a great doctor.


Those nurses taught me some valuable lessons.


They taught me it’s okay to see patients as people.


They ARE people.


They taught me it’s okay to grieve.


Medicine IS grief at times.


It’s funny how life takes twists and turns. Fast-forward 15 years.


A few months ago, I was asked by my organization to work on a project about the culture of medicine we create. If I agreed to help, I would be paired with a hospital administrator who helps lead our clinical enterprise. 


His name was Mike.


It was a very easy decision to say yes.


As a physician, I have been blessed to have some phenomenal teachers who taught me many things about the culture of medicine. Nurses, pharmacists, respiratory therapists, physical therapists, perfusionists and other physicians have all taught me that medicine is human work.


I think if you asked Mike and me, we would both say, it is the best kind.


Interestingly, I have spent the last 12 years studying heart failure in surgical patients.


Funny, isn’t it?


If you are medical student, spend time with the nurses.


They are wonderful teachers.


#resilience #healthcareteams #womeninmedicine #nurses #womeninSTEM