Medical school did not prepare Sarah Stein for the cold, factual way her colleagues dealt with death. When she asked one of the doctors, she worked together on how they could move quickly after the patient died, and they explained that it was not a lack of care – it was self-preservation. In public hospitals where beds, wards and passages are filled with death and illness, she says, letting you get mad by it, not run away. She doesn’t know if she’s trying her job or not.
It was the first time my patient died at age 21. It wasn’t like Gray’s anatomy. There was no moment of silence, no flatlines in the background, nor no family crying outside the door. It was cold and it was a real problem.
The intern looked at me and said, “There are another 100 people in the waiting room, so it’s better to move.”
I didn’t know why no one seemed to bother me. I felt hopeless. The doctor moved mechanically to summon the family. The nurse followed the protocol. Wordwork continued as usual. Someone added “end of mise” to the whiteboard. Someone else shrugged, noting that the patient was on the way to HIV anyway.
Later, when I asked one of the doctors how they could go quickly, they explained that it was not a lack of care – it was self-preservation. It was just a reality.
Healthcare workers do not deal with death, they separate themselves from it. This may seem heartless, but I think that is the only way they can spend their days. The beds, wards and passages are filled with death and illness, and not taking a step is to make sure you get caught up in it. Death is part of work and a gear in a machine.
Working in a public hospital with too few resources will punch you in your gut every day. It’s not just the trauma of seeing your patient die – there are no gloves in the delivery room. There are no alcohol swabs to clean the scratches. And since the clinic is gone, nurses know they will stop by the store on their way to buy their own gloves and masks. The waiting time for scans is several months longer, and surgery can progress unnecessarily until the illness becomes inoperable. It’s a limited bed of high care, meaning that doctors are forced to make regular decisions to decide that they deem more worth saving more lives as they have only one space.
As students, we are really not prepared for this. We are expected to know all theories. All systems. All medicines.
We deal with death as an academic topic. Our palliative care lectures teach you about prescribing morphine at the end stages of cancer. Learn what happens when body tissue dies. But we never deal with how it feels to spend every day in the face of death in the face of failure in a system of failure.
No one will teach us how to navigate our sadness. In the face of moral distress, no one prepares us from a way to speak out from within the toxic hierarchy or balance this kind of work with life outside the hospital. We don’t teach you how to hone the sleazy comments from older people, or how to deal with stupid feelings in a round of wards, no matter how much you read.
It’s funny – I think you know these things. After all, many people tell you that medicine is difficult. I probably should have listened more carefully. The medicine is difficult. But it’s not an abstract way. It’s difficult in a very specific and concrete way.
It demands enormous sacrifices. It will release the tip to you. It will burn you before you start. It forces you to be surrounded by suffering at all times. It’s difficult because you know that the system remains unchanged and will be difficult forever.
Still, there are moments. The moment of humanity. A moment that reminds me where I am. In the middle of rants about a difficult day, my mother definitely tells me how lucky I am to be a medical student. Usually I make this annoyed and infuriated. But deep down, I know she is right. How many babies in their 20s witness their first breath? Or do you look inside the body? Or do you see psychotic patients slowly regain clarity?
Last year, during my internal medicine rotation, I spent a quiet night over the phone. I spent most of it with one patient. An elderly man was admitted in a state of delusionalism. He was confused all night, but I had time so I was with him. I checked him in frequently and chatted with him as much as I could.
During the morning ward round, he told an advanced doctor that I am the best doctor in the world. Of course, I was just a student and I was regretted. I didn’t do much at all (and he was still a bit confused). That patient will be with me forever. He reminded me of the real value of being a healthcare worker. I didn’t really treat him, but I made him feel like I took care of him. And that made a difference.
But if I’m honest, I hate medicines often and I can’t spend more life on this. At the same time, I am afraid that I will not be able to find anything else meaningful. If I don’t continue and use this power forever, I’d feel like a fake. Perhaps if I choose to leave, I would ignore my better or more honorable version. There is something incredible about being there for people at the most vulnerable moments. About witnessing life, death, survival, and everything in between.
That first patient’s death is still sitting with me. Not because it was dramatic, but because it wasn’t. It was quiet, clinical and cold. For doctors, when they own back-to-back patients or broken infrastructure patients, they don’t have time to feel everything. For me, that loss as a student was raw. I’m not paralyzed from the system yet. Whether it is strength or debilitating, I hope it doesn’t become.
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So I don’t know what the future will be like. I don’t know if I’ll stay with the medicine, find something else, or change the path completely.
I have considered taking a business course or trying out the humanities. I thought about doing 180ยบ and studying acting. There is always a chance I can find my billionaire and become a mother in a happy home.
The doctor I speak of is obsessed with me going through medical school without being convinced I want to be a doctor. I’m sure my parents will be worried about landing me as a full flop.
All I know is that this piece shaped me in the way I am still trying to understand. And because of all that confusion and pain, I feel lucky to have been part of it – even after a while.
Sarah Stein is a fifth-year medical student at the University of Cape Town.
This story was produced by the Bhekisisa Center for Health Journalism. Sign up for our newsletter.
