II. That One Patient

A medical student’s encounters with Death

Written in 2023

I once worked in “emergency family medicine”. Patients would call me with their symptoms and I had to determine whether it could wait or not.

Many times I wondered. Had I made the right decision?

Until one night I didn’t. I underestimated my patient’s suffering. I booked him in for a phone consultation.

He died later that night.

I still wonder if I had doubted my decision that night. If I had thought of him before falling asleep.

I only found out a month later. I had just come back from a weekend trip with two girlfriends.

I had allowed myself to go out and have fun. To not suspect what I had done. I couldn’t even cry.

My manager assured me they would support me. “It happens to most of us at some point.”

“They say general practitioners could fill a cemetery with the patients they’ve lost”

They would be there for me. I could call them if I wanted. I could give away my shifts. Take time off.

I cried when I left. The voice of his worried partner in my head.

I took her love away from her. I had taken advantage of their trust.

How could I allow myself to believe I was capable enough to make decisions on people’s lives?

My view of medicine and myself was forever altered. Everything felt surreal.

I would receive support but it was my patient who had died. It seemed like a twisted joke.

My whole existence felt immoral.

I had thought about death before, but always thought my fear of pain would “protect” me. But I was responsible for another person’s death so surely I was capable of everything.

In bed at night, I thought of balconies. Leaving behind an open door and a curtain moving with the wind.
I biked past canals and thought of driving into the warmth and peace of the water.
…

I never willingly talked to my manager about it.

I talked to a few doctors whom I trusted. I came to them with shame. They said these things happen.

Some had lost patients of their own.  “ you shouldn’t blame myself. shouldn’t continue with a job that makes you doubt your decision to study medicine.”

“ You will learn from it. You’ll never miss the signs again.”

Inhumane.
His wife had called for help. She had done her best.
It was all in vain.

“My patient had to die for me to learn”

…

The patient had made it to the phone consultation with the doctor.

But the doctor had missed it too.

For the weight I felt being lifted off my shoulders, I’ll always feel guilty.
I hadn’t been the one to give the final advice.

The doctor’s mistake weighed more on me. I saw his misinterpretation as a constant – mine was variable.

Had I recognised the signs for what they were, the doctor would have never been involved.

The only chance to save him had been mine and I had wasted it.

…

The patient was as old as my first grandpa had been when he died. More than twenty years ago. From an aneurysm mistaken for back pain. Just like that of my patient’s.

…

I wonder if my patient had a feeling of desperate urgency, of impeding doom. I feel it too; when I think of him that night.
I kept waiting for my manager to call me and tell me that it had all been a lie.

Everyone makes mistakes but health care professionals’ mistakes can cause lives.

“Mistake” sounds like an excuse

The memory of that one patient will always be with me.

I let him down and I’ll forever regret not doing better.

…

That one patient (“Die ene patiënt” in Dutch) is a Dutch book I read, made out of true stories, from various health care professionals about a patient they’ll never forget.

My patient who died that night is my “that one patient” .