WARNING: This is not a happy feel good post. It's about someone dying, you might not want to read it.

Last week my preceptor and I were talking about things I needed to see and/or do yet before I'm done in the ER. She said I needed to put an NG tube in and I needed to watch somebody die. I thought that last one was a bit morbid but I figured she knew what she was talking about. I've seen and participated in several codes but amazingly they were all brought back and stabilized. I figured that I might get to put an NG tube in someone but I really didn't think I would see someone die. Literally the next day I got my chance.

From what I hear usually when someone dies in the ER there is a flurry of activity with people doing everything they can to save the person. This wasn't the case this time. This patient had liver cancer and was brought in via ambulance because she was bleeding out. The patient had requested that no heroic measures be taken or machines be used to keep her alive. So all we could do was watch and wait for her to pass. That is the hardest part in medicine, watching and waiting. I stood by watching the woman fight for every last breath...every last heart beat...every last second. The look in the woman's eyes when she realized what was happening to her was unforgettable. It was a look of complete terror and panic. I felt helpless standing there. The only thing we could do was give her pain medication to make it a little more tolerable. Slowly, with every passing minute, her pressure continued to fall and her heart rate slowed. Eventually she quit fighting and was overcome with complete peace.

Death is a necessary part of life and unfortunately as clinicians a part of life that we have to get comfortable with. I guess I'm comfortable with death in and of itself but I'm not so sure anyone can ever be okay with actually watching the human body die. Yes it's systematic in nature but you still cannot remove the humanity from it. You realize that this person is suffering and that with every organ system that shuts down that suffering increases until eventually it's over. It's a relief for everyone involved when it's over. That was one of the hardest things I've ever had to watch and sadly it probably won't be the last time I see it.

This was an experience that I will not soon forget.