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Learning to Grapple with Difficult ‘Firsts’ in Medical Training

A medical professional performs CPR.

For most trainees in the medical field, there are “firsts” that we will likely never forget. Some of these — hopefully most of these — are memorable in a good way, such as delivering our first baby, or successfully placing a peripheral IV or central line for the first time. But there are also some firsts that we dread — such as doing CPR on a patient or announcing time of death.

I am currently about two months into my internal medicine residency at Johns Hopkins Bayview Medical Center, and I have already experienced both of these “dreadful” firsts. My first time doing chest compressions on a patient happened during an overnight shift in the cardiac progressive care unit, when a patient on another team unexpectedly coded (had no pulse). Although I had done chest compressions countless times before during simulation sessions, performing it on a real human being had a different feel and a different smell that I will never forget. Though the patient unfortunately did not recover, the camaraderie I felt among the team members that night is something that will stick with me for a very long time.

While on an overnight shift on the wards just a few weeks ago, I was called to a patient’s bedside to perform my first death exam. I have admittedly dreaded this moment since I first decided to go into medicine. I dreaded having to call the patient’s family to tell them the bad news, and subsequently ruminating on what, if anything, I could have done differently. But the reality of this first experience was far less distressing than I imagined. When I went to the patient’s bedside, his face looked calm and tranquil, and he appeared to have passed peacefully in his sleep. I checked for breath sounds, a heartbeat and pupillary reflexes — all of which were absent — and then I called the time of death. I also called his wife, who, to my surprise, sounded relieved that her husband was no longer in pain. Overall, the experience went surprisingly smoothly, and I didn’t even have to second-guess what I could have done differently.

More than anything, these experiences remind me that sometimes our apprehension toward unfortunate outcomes in medicine — particularly death — may be more anxiety-provoking than the events themselves. I have no doubt that I will encounter many difficult deaths during my medical career, but at least I now have experiences to remind myself that these events do not always have to be traumatizing or unsettling. Looking forward, I hope I continue to approach these firsts with a new sense of curiosity and with an open mind that reality may be much kinder than my preconceptions.

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