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Diary of an FY1 – An Uncomfortable First

September 24, 2014

The biggest cumulative lesson of these past eight weeks has been discovering just how little I know. I spent six years in medical school and I’m trying hard to think what took up so much time. Being a brand new junior doctor is a narrative strung together from a myriad of “first” experiences. First time someone said “Thank you, doctor.” First time taking blood from a foot. First time on-call.

First death.

Most of the time, the fiction in my head is that my business is all about saving lives and kicking ass. More accurately, postponing death. And most of our patients aren’t quite that sick anyway. But a few patients have passed away since August. I want to say they went gently into that good night. I want to say we made their last days comfortable. That’s an assumption on my part.

We came in one morning to find that one of our patients had died during the night. It was entirely expected; a matter of when, not if. It fell to me to take care of the ensuing paperwork. Most of it is entirely benign, repeating on different forms the likely reason of death. It was an almost pleasant way to spend the morning in the Bereavement Office. But for completion, I also had to examine the patient post-mortem.*

The kindly bereavement officer led me to the mortuary, tucked away in one of the auxiliary buildings far away from the main hospital. The assistant there was surprisingly cheery and pleased to have guests. She led me into the mortuary, light, high-ceilinged and clinically tiled. She opened one of the many doors set into the walls and withdrew my patient on a tray.

That was a profoundly unsettling moment. Right up until the day before, I had seen this patient living and breathing. I had been invested in him in the form of different antibiotics and procedures. Now he lay there still, skin sallow and leathery, mouth slightly agape. I don’t know if he looked peaceful or not.

It wasn’t my first encounter with a dead person. I remember my nan passing away after a short embuggerance with cancer, swathed in the sheets of her bed in the dining room. I remember the man who donated himself for our first year dissection, a muslin cloth respectfully covering his face. It wasn’t even my first time in a mortuary, having occasionally followed junior doctors as a student after a dimly perceived educational need.

But this was different. This was my first experience with a patient who had permanently moved beyond my capacity to help or harm.

* In order to complete a cremation form, a post-mortem examination is required to check the patient doesn’t have any dangerous substances in their body. In practice, this means checking for a cardiac pacemaker – they can cause the furnace to explode (so I’ve been told) during cremation. Lesser known, brachytherapy seeds, little blebs of radioactive material, can quiet irradiate the town if they get cremated!

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