- Sarah Stein found that medical school did not ready her for how bluntly and dispassionately her coworkers addressed death.
- When she questioned one of her colleagues about moving on so rapidly following a patient’s death, they clarified that this didn’t indicate a shortage of empathy but rather an essential act of self-protection.
- In public hospitals, where beds, wards, and corridors are overrun with illness and mortality, she believes that failing to distance oneself means allowing this environment to envelop you completely. She doubts her ability to handle such a challenge.
I was 21 the first time a patient of mine died. It wasn’t like Grey’s Anatomy. There were no moments of silence, no beeping flatlines in the background and no weeping family members outside the door. It was cold and a matter of fact.
The intern looked at me and said, “There’s a hundred more in the waiting room, so you better get moving.”
I couldn’t grasp why nobody appeared concerned. It left me feeling utterly helpless. The physicians went through the motions of informing the relatives. The nursing staff adhered strictly to procedure. Routine tasks in the ward proceeded without disruption. One person wrote “demise” on the whiteboard. Another simply nodded, mentioning that the patient was dealing with late-stage AIDS regardless.
Afterward, when I questioned one of the physicians about their ability to shift focus so rapidly, they clarified that this didn’t indicate a shortage of compassion—it was an act of self-protection. Such was life in that environment.
Health care professionals do not engage directly with death; instead, they distance themselves from it. While this may appear cold-hearted, I believe it’s essential for them to function daily. Hospitals brim with mortality and illness everywhere—beds, wards, corridors—and failing to detach oneself means succumbing entirely to despair. In due course, dealing with death transforms into just another aspect of their duties, an integral component of their work routine.
Working in a public hospital with way too few resources punches you in the gut every day. It’s not just the trauma of seeing your patient die — it’s having no gloves in a delivery room; no alcohol swabs to clean wounds; and knowing that nurses stop at the shop on their way to work to buy their own gloves and masks because the clinic has run out. Waiting times for a scan are months long and surgery delays needlessly let disease progress to the point of being inoperable. It’s the limited beds in high care that mean doctors are regularly forced to decide whose life is worth saving more because there’s only space for one.
As students, we always find ourselves unprepared for this challenge. We’re supposed to be well-versed in all the theories, every single system, and each medication.
We approach death from an academic perspective. In our palliative care classes, we study topics like administering morphine during the final phases of cancer and understanding bodily decay. However, these lessons fail to address the emotional weight of confronting mortality daily within a flawed healthcare framework.
Nobody instructs us on managing our personal sorrow. Nobody equips us for resilience against ethical anguish, voicing concerns from inside a poisonous power structure, or balancing such work with life beyond the clinic walls. We receive no guidance on disregarding condescending remarks from superiors or dealing with feelings of inadequacy during rounds, regardless of additional studying we might undertake.
It’s amusing how we assume we understand such matters. Despite numerous individuals warning us about the complexity of medicine, perhaps I should’ve paid closer attention. Medicine isn’t challenging theoretically; rather, it presents difficulties that are palpable and specific.
It requires immense dedication. It gradually erodes you. It exhausts you before you start. You’re continually exposed to pain. It’s difficult knowing the system won’t improve, making it perpetually challenging.
Even so, there are instances—moments filled with human compassion. These reminders highlight the extraordinary opportunity I have been granted. During one particularly intense vent session recounting a challenging day at work, my mother consistently reassures me about how fortunate I am to be pursuing medicine as a career. Typically, her comments evoke frustration and anger within me. Yet beneath those feelings, I understand that she speaks the truth. How many people in their twenties can say they’ve seen an infant take its very first breath? Or had the chance to peek into the inner workings of a living person’s body? Or observed someone struggling with mental illness gradually recover their lucidity?
Last year, during my internal medicine rotation, I had a quiet night on call. I spent most of it with one patient, an elderly man admitted in a delirious state. He was confused for most of the night, but I had time, so I stayed with him. I checked in on him often and chatted with him when I could.
During morning rounds, he informed the attending physician that I was the finest doctor globally. Naturally, this left me quite embarrassed since I was merely a medical student. In truth, my involvement had been minimal, and perhaps his compliment stemmed from some confusion (he might have still been somewhat disoriented). This particular patient’s case has stayed with me throughout my career. His comment underscored the genuine importance of working in healthcare. Though I did not provide substantial treatment, ensuring he felt attended to proved meaningful nonetheless.
However, to be truthful, I frequently despise medicine and struggle to imagine dedicating much more of my life to it. Simultaneously, I fear that I might never discover another pursuit as fulfilling. If I were to abandon this path and fail to utilize this capability for positive change, I worry I’d perceive myself as fraudulent. It’s possible that opting out could mean overlooking a superior or nobler iteration of myself. The experience of supporting individuals during their most fragile times holds an extraordinary allure. Observing birth, death, resilience, and all experiences in between is profoundly impactful.
The passing of my first patient remains etched in my memory. It wasn’t due to any drama; rather, it was marked by its stark lack thereof. The event unfolded quietly, methodically, and chillingly. As for the medical professionals, they often find themselves too overwhelmed by an endless stream of cases and crumbling facilities to fully process their emotions. But as someone learning this profession, that sense of loss hit me deeply. I haven’t grown indifferent within this system, and regardless of whether this resilience is a virtue or flaw, I pray that I always retain some part of myself like this.
Therefore, I am uncertain about what the future entails. It remains unclear whether I will continue in medicine, explore an alternative path, or make a complete career shift.
I have pondered enrolling in business classes or exploring humanities subjects. Another idea has been to completely change direction and study acting instead. And of course, there’s also the possibility that I might meet my personal millionaire and become a content homemaker.
The physicians I converse with believe I am out of my mind for pursuing medical school without being certain about wanting to become a doctor. I am positive that my parents will fret over the possibility of me ending up as an utter failure.
I am aware that this experience has molded me in aspects I continue to grasp. Despite the turmoil and suffering involved, I consider myself fortunate to have participated in it—even if only briefly.
Sarah Stein is a fifth-year medical student studying at the University of Cape Town.
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