Long story here, but I hope meaningful.
One of my hardest experiences in clerkship happened at the end of my Internal medicine rotation. On call one night, I admitted a 25-year-old woman. She had been declining for a while and was now fairly ill. And yet despite a battery of tests for the rest of that week, no clear diagnosis was made. The entire time I followed her personally, and tried my best to help with the diagnostic process, as well as communicate with her family the difficulties we were having.
One week later, we still had no diagnosis, and without warning, the patient went into status epilepticus. Our new CTU staff was paged – but because she was new that week, she had not even met the patient or the family. I found myself beside her, among all the staff from the ICU team who were busy with intubating. I realized that I was the only one present who knew the patient well; but found myself struggling to mount the courage to present myself as such to this team of professionals. In the end, I meekly accepted helping to bag mask, all the while feeling distressed that my patient was declining, that I could do nothing helpful, and shocked by how nonchalant the team was about the situation.
The patient was eventually moved to the ICU. A kind resident brought me with them, and I helped her put in a central line. To my continued amazement, she quizzed me on drugs for status. At the time I couldn’t understand how she could ask that, when it seemed a life or death situation.

I left that evening to study for my iOSCE the next day. The day after that was our Internal medicine OSCE. By the end I was completely fried, but I arrived back at the hospital for an evening call that night, and ran into one of the senior clerks – Who flatly informed me that the patient had died Tuesday morning, from a disease I had never heard of before (HLH, for the record). Her passing, and the entire debrief with family and staff had occurred over the two days that I was away. I had not been included, due to being away for exams, as well as, honestly, being just a clerk – apparently.
For the rest of the week, no one talked about the case. Because our staff was new that week, she didn’t have much connection to the patient, and never mentioned her again. Our senior resident also left that week, so there was no one to help me sort out the feelings I was having. I felt shame, that I hadn’t figured out what her illness was, or been able to help in her care at the end. I felt rejected by the staff who hadn’t included me in any debriefing process; and I felt anger at the establishment, who didn’t seem to care that a 25 year old girl had just died, and more about the “interesting” disease she had had.

For weeks after the rotation ended, I struggled with deep discouragement. I was crying often, and missed some days of the next rotation. I felt extremely tired of everything related to medicine. Eventually, I reached out to an OPHSA counsellor who started chatting with me weekly. We worked out many of the feelings that come with “your first death”, as well as the difficult experience of internal medicine in general. She felt that I was showing symptoms of burnout, and in retrospect I agree. It took a bit of time and self-compassion, but eventually the darker feelings improved.
The lessons I think I’ve learned that I’d like to share – You may be “only” a clerk, but never sell yourself short; You have a huge impact on a patient’s/their families experience. All the same, don’t get down on yourself when you are out of your league (and this will happen). 2) Your patients will die, and it may be okay for you, or it may really, really suck. Many doctors see that happen everyday, and their reactions are normal; Just like your reactions and feelings are at your stage. Please talk to someone about them. OPHSA is great for that. 3) Burnout happens in medical school; its not a sign of weakness, but often of caring very much. Talk to people about that too 😊

 

– CC4