Simulating Sorrow: How Medical School Has Prepared Me to Acknowledge the Emotions of Life and Death

“One minute remaining.” 

Never have these three words brought me such relief.

It was our third SIM lab as first-year osteopathic medical students at Pacific Northwest University, and my first SIM lab as lead. After what felt like a few brief seconds we’d stabilized Apollo, our patient, and, to that point, done what we could to diagnose and treat him. Then, the beeping started to slow.

I looked around and saw the panicked looks on my team’s face as we watched Apollo’s oxygen levels fall and the pressure start to drop. Within seconds I found my hands fumbling with the laryngoscope as we tried to intubate, with that beeping sound fading and the beat becoming slower and slower. In that moment, I remembered my first code in the ED.

The same beeping echoed dully through the room as I watched an 86-year-old male fade in front of me. His family sat at the bedside, sobbing and holding his hand. My mind flashed back to the time I witnessed a family lose their 18-month-old suddenly after a car accident with a drunk driver. I recalled the shrill of a mother’s crying. Her unbridled pain echoing down the hallway. Back then, I merely stood in the room, documenting the final chapter in these patient’s lives, wondering what other stories would have filled the pages of their lives. Now I stood in the room, cloaked in overwhelmed silence despite the chaos around me, with the fragility of this patient’s life balancing in my hands.   

My team worked diligently at my side to get the patient intubated on one of the trainer modules. I was at the head of the bed, attempting to place the endotracheal tube. Everything felt rhythmical: continue bagging the patient, check the tubing to make sure it’s intact, insert the blade, visualize the cords, guide the tubing in, confirm placement. I waited to watch the chest wall rise and saw no motion.  

To the side, my team had successfully intubated the patient. The simulation was over. But an ominous feeling washed over me and the reality of what it meant to be a physician struck me. Had it just been me in the room, I would have killed that patient.

As a medical student, I have this predisposed idea of what it will be like to be a physician. I know the sacrifice, determination and grit that it takes to just get to this point in my professional career. I spend every waking moment studying, and it’s not for points or the satisfaction of seeing my grade in a course. I don’t commit checklists, medications or physiological pathways to memory to pass my classes. I also don’t spend hours in a formaldehyde saturated lab, intricately dissecting the human body, just to pass a lab exam. Instead, I – and I believe we, as medical students -- are doing this for my future patients so that, one day, when I am the only thing that stands between life and death, I am prepared.  

I also have to be prepared to accept that I can, and will, fail.  

Reflecting back on that moment when I watched two different lives -- one just barely beginning and one that had been filled with memories -- I realized that losing a patient, or even a SIM patient, would never be easier, despite the fact that we are trained to become immune to it.  

A physician once told me that you must continue to feel, even in the most emotionally draining situations. It never will become easier losing a patient, but I have to feel it. I must let it overwhelm me.  

“It never will become easier losing a patient, but I have to feel it. I must let it overwhelm me.  ”

After our debriefing, I left the room feeling nauseated by the fact that, in a couple of years, the patient I just lost would be someone’s son. The patient in that bed would be a person, filled with love and memories. My hands were still sweating and shaking from holding the Mac Blade in my hands.

Instead of shutting out the emotions, I let them come in waves, acknowledging the flood of adrenaline, compassion, fear and relief.

Ashley Penington

Osteopathic Medical Student - 2nd year (OMS II)
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences