You Always Remember Your First

Joel Hillman (Pharm IV MPS) recounts three deaths.


I remember once being told that, in the medical industry, ‘everything we do is a stall’ (which I think is actually a Scrubs quote, but is powerful nonetheless).

There is this idea in medicine that you take on the responsibility to be entangled in deaths. You are responsible for deaths, one way or another. Either you kill someone with a mistake, or your treatments fail and they die. I think this burden is an interesting sacrifice that people make for the community. And I think it is a burden.

The first death I ever saw was a patient in China. He was old, he had been using a drug called digoxin, but because of an error somewhere along the way, had been using many times the dose he should have. His heart essentially tore itself apart. My professor told us quietly after [his/her] pager interrupted our lunch. I remember the other student was shaken, and took the remaining fortnight we were there to recover.

There is also a saying that you always remember the first patient you kill, which is much more interesting an idea in my opinion. A professor told me about his. He still remembers her name, her husband’s name, and the names of her three children.

The second death I want to tell you about occurred on a Thursday evening two weeks ago, when a patient went into cardiac arrest after major surgery. She was old, and she was Not For Resuscitation, which means exactly what you think it does. It is a myth that people who undergo cardiac arrest are always just zapped back to life with chest paddles, and the team and the patient had together decided this was the best course of action.

A code blue stops most of the ward. The siren echoes through the halls, the screens flash the bed number (22. 22. 22.) and nurses run carrying drugs and machines. I watch as doctors, nurses and my supervisor (a clinical pharmacist) run toward the room and just stop.

There are staff specialists, registrars, interns, nurses—all highly trained individuals ready to work as a team with all the medications and equipment they need to save a life. But they can’t. So they just stand and watch an old woman die.

Or they don’t. One nurse is on her phone. One doctor is reviewing a chart.

She dies, the siren stops, the screens return to normal, the nurses pack things away, the doctors continue on their rounds, and the pharmacist tells me to go back to counseling a patient on the medication they’re beginning.

The third death happened on the change of a shift, when a registrar entered the room, and immediately paged, said ‘Ha! What a start to the night’, pulled out her headphones and began writing notes.

Death is normal. It’s a thing that happens, and no one has time to dwell. This is probably the best way of dealing with it—or you don’t, like my colleague. She’s choosing not to engage with that facet of the job right now, which you can do more easily from private practice pharmacy.

I guess my point is that this is all normal. You remember your first, because of course you do, but then you remember that the rest are just case lessons to be learnt. Nothing more. The medical industry has what looks like an unhealthy relationship with death, but it’s really the only way to get it done.