A Resident's Review

Disclaimer

The stories detailed below involve death. Many details of these stories have been altered and anonymized to protect the privacy of patients. These are only a few of many different stories, and every patient’s situation is unique. I am making no implications of an appropriate way to handle these tragic scenarios.

Table of Contents

1. Letting Go
2. A Journey to Acceptance
3. Enthusiasm in the Face of Uncertainty
4. Final Reflections

Letting Go

I walk into the room and my ears began to ring. Various beeps, buzzes, and clicks emitted from different pumps, screens, lights, and other medical devices filling the room. Before me lies a deceased man with a beating heart. He is technically alive but sustained by an array of machines. His heart continues to beat thanks to two medications being pumped into his bloodstream to maintain his blood pressure. A large tube protrudes from his mouth, connected to a ventilator that performs the work of his lungs, regulating his every inhale and exhale. Another machine intermittently filters his blood, performing the function of his kidneys. In the medical world, we refer to these supports as dialysis, mechanical ventilation, and pressor support—forms of life support.

The man before me is unaware of my presence. He is a stranger to me; I have never had the pleasure of a full conversation with him. Upon his admission, he was in a state of delirium, unable to hold a coherent conversation. He was dying. He has been seen by numerous doctors from various specialties, all of whom have reached the same conclusion that he is unlikely to recover. Yet, despite not knowing him personally, he does not feel like a stranger to me. Each day, I learn more about him from his family and friends. His family members tell me of how he loved animals, enjoyed stayed active, and was quite the jokester. They spoke of his resilience, describing a man who rose from a poor upbringing to become a successful businessman. Though I’ve never spoken with this patient, I feel as though I know him.

I wanted to see him recover, yet I knew this was not possible. I knew I had to ask his family to make one of the hardest decisions of their lives: to let their loved one go. Over the coming days, I shared the difficult news with his family. He will not survive without life support, and he is unlikely to ever come off it. This is his new state of being—unaware of the outside world and sustained by machines. Despite seeing their loved one in this state, they were not prepared for this news. They knew he had been sick for some time and had a long list of health issues. Nevertheless, they were not ready for their time with him to end.

He had been in and out of the hospital over the past few years, losing a bit more of his ability to function each time. However, each recovery granted him more time with his family, allowing him to return to the person they loved. It was clear he was cherished by many. Over the following days, the family experienced a whirlwind of emotions—arguments, regrets, grief, sorrow, denial—but ultimately, they reached acceptance. Through careful observation and listening, I knew they had all come to the same realization: their loved one would not want to continue in this state. Letting him go was not an act of giving up, but a gesture of compassion and respect for his peace.

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A Journey to Acceptance

As I approached the patient’s room, I saw the nurse call light flickering above the door, a flashing yellow that signaled the patient was requesting assistance. The nurse was tied up helping the patient next door, so I decided to walk in and see how I could help. This patient had just been admitted, and this would be my first encounter with her.

Upon entering the room, I saw a woman who was nothing but skin and bones. She was extremely frail and underweight. Each bone of her skeleton was apparent through her thin skin. I introduced myself as one of the resident doctors taking care of her. With a gentle smile, she asked me if I could help her transition to lying on her side. She had been lying flat on her back and was starting to hurt from this position. I put on gloves and began assisting her. As she moved, I could see the contractions of every muscle across her joints and the rise and fall of her ribcage with each breath. I worried that her bones might shatter at any moment. Her illness had reduced her muscle mass to the bare minimum, leaving her too weak to move on her own.

I knew very little about the patient aside from some concerning blood tests collected hours earlier. Fortunately, she had brought with her a dense stack of paperwork containing medical records from a recent hospital stay. I left the room to study them. The pages told a grim story: various specialist consultations, CT scans, MRIs, procedures, and bloodwork demonstrating a failing liver and pancreas. To keep her alive, a tube had been inserted to feed continuous nutrients into her digestive system. If this tube was removed, her blood sugar levels would begin to plummet, she would stop breathing, and eventually her heart would cease to beat.

During her prior hospital stay, she was sent to a physical rehabilitation facility in hopes that she could become strong enough to undergo a liver transplant. Unfortunately, she continued to succumb to her illness and ended up under my care. I knew in her current state she would not survive a transplant. Her conditions were not reversible. She was near the end of her life.

I tried to inquire how much she understood about her current condition. “Do you know what is causing you to be so sick?” I asked.

“I know something is wrong with my liver. So, what’s the plan? I’m ready to start on some kind of treatment to get back to my normal life.”

From this brief exchange, I knew she did not understand the gravity of her situation. There was nothing available through modern medicine that could fix her underlying condition. This was going to progress, and fast.

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Enthusiasm in the Face of Uncertainty

As I walked down the hallway towards my next patient’s hospital room, I heard a robust laugh coming from the doorway. Entering the room, I saw my patient laughing and conversing with his nurse. His laugh was full of charisma, and the joy in his voice brought a smile to my own face. His radiant smile almost distracted me from the bright yellow glow of his skin. Observing from a distance, I noticed the whites of his eyes were also bright yellow. This was not a good sign, but I was glad to see that, at least for the moment, he appeared to be happy.

I introduced myself, and within minutes of our conversation, I could tell this man was a “glass half full” type of person. Despite being in the hospital, he was in good spirits and happy to meet new faces. I told him about my plan to figure out what might be going wrong.

“Sounds great to me,” he said. “Whatever it is, I’m ready to find out. I’ve been feeling horrible for months.”

I remember his enthusiasm in the face of uncertainty, and to this day I still admire it.

Yellowing of the skin, medically known as jaundice, can be caused by a variety of ailments. I was hopeful we could get to the bottom of the issue and get him feeling better soon. The following day, I discovered the source of his misery. A CT scan demonstrated widespread metastatic cancer, with several tumors growing within his body. Several of his organs were beginning to shut down due to the stress this was causing his body. With his liver impaired, waste products had begun to build up in his bloodstream, turning his skin and eyes yellow.

In his current state, I knew his body would be unlikely to survive the stress of chemotherapy and radiation. This disease was going to end his life. I felt distraught. Only yesterday, this man was laughing and full of joy. I did not want to be the bearer of this tragic news. Later that day, I shared the results of his tests and what they meant. I told him he could speak with an oncologist—a cancer specialist—to discuss potential treatment options and the course of his disease. He took a long pause, looking out the window as he processed this information.

“I have fought cancer twice already in my life. They were hard-fought battles, and I just know I don’t have what it takes to go through that again. It is what it is. I’ve lived a good life,” he said, with a smile on his face.

“If you knew you were going to die soon, what would you want to do most?” I asked.

“What I want most right now is to be at home in bed with my dog. He’ll be missing me a lot by now,” he chuckled.

“I like that. Let’s make that happen for you.”

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Final Reflections

Death comes for all of us, some earlier than others. For many, the hospital is a place of recovery. For others, it is a place of death. When I went to medical school to become a doctor, I was excited to learn how to help people. At the time, I thought that meant preventing death and seeing people recover. Often, this is the case, and I frequently see individuals who were once clinging to life return to living fulfilling lives. However, some patients come to me at the end of their lives.

I now understand that “helping people” in medicine has many meanings. For some, it is healing from their physical illness; for others, it is easing their suffering; and for others, it is navigating the process of dying. There are no right or wrong answers, and what constitutes a “good” death may look different from person to person. There exists a delicate balance between the hopes of recovery, the harsh realities of physical disease, and the limits of the human body.

Each encounter with death shapes my perspective on life and death, and I learn as much from my patients as I do from textbooks. I am continuously amazed at how strong individuals can be when faced with terrible realities. I am honored to be part of this process and continue to grow personally through these experiences with my patients.

While I do not wish for anyone to toil in anxiety contemplating their own death, I believe it is beneficial to reflect on the brevity of life and what a “good” death means to you. These are questions we may never consider until we are faced with death, and having pondered them beforehand may help you navigate that day in the future. Life is always a gift, and we are not guaranteed tomorrow.

I hope that in reading these stories, we can all come away with a sense of gratitude for our own physical health and the good things in life we do have.