This was the longest walk of my life. 3am in the morning and I was about to pronounce my newly admitted patient dead. You could hear a pin drop as I walked down the never ending 4th floor hall towards the elevators.

It was only the second week of my internal medicine intern year. Still wet behind the ears, I certainly wasn’t ready for what that night had in store for me. My upper level resident was paged from the ER to admit a very pleasant, middle aged, African American lady for abdominal pain. It turned out this patient had been diagnosed with an aggressive (triple-negative) breast cancer months ago but refused therapy. She now presented to the ER with diffuse abdominal pain. Walking into the ER, I wasn’t prepared to have my senses tested that way. The patient had a fungating left breast cancer wound showcasing a full range of neon colors and purulent drainage. The two fans and air freshener in the room could not mask the putrid smell emanating from the lesion. Despite her pain, the patient had a very sweet personality. She shared her distrust for the medical system and after the diagnosis of breast cancer nearly a year ago, she decided she would quietly live out her remaining days at home. I recall the patient sharing with me how proud she was to see a young African American male practicing medicine. This was not something she was accustomed to seeing.

After examining the patient, I hurriedly left the ER and took the elevator back up to the internal medicine call room. I shared the case with my resident who then evaluated the patient herself. We diagnosed the patient with an acute abdomen likely from metastases to the abdomen and paged the trauma surgeon hoping for STAT surgery. Unfortunately, a different path was taken as the surgeons were slammed with multiple trauma cases and the ER staff transferred the patient up to the medical floor without our knowledge. Two hours later, my resident was paged that the patient had expired. I was then the chosen intern to call the death.

So there I was, walking to pronounce my first death. This was something I had never been trained to do. I had no clue how to officially call someone’s death. I had witnessed a few deaths as a medical student, however I never dwelled on the protocols surrounding such tragedy. This was a patient full of life, smiling and having a pleasant conversation with me a few hours ago. She declined resuscitation (DNR) but I couldn’t help to feel bad that emergency surgery was not performed. What if the nurse was incorrect and the patient was still alive? Maybe she was just sleeping and all it would take would be a little bit of nudging. Sweat beads began to form on my forehead. I nervously began flipping through my memories of old TV medical drama episodes hoping to stumble upon clear instructions. My trusty pocket reference book also provided no immediate answers.

And then… I walked into the patient’s room. Pure silence.

I shuffled around the bed staring at the patient. I then began to think of how privileged I was to be one of the last people to speak with this lady. I had the honor of officially placing the period at the end of her life. I don’t know if I impacted her life in the slightest bit those few minutes we spent together but she would forever impact mine. This is one of the many privileges of being a physician and I think every young trainee has encountered this special moment. In the middle of the night while others are asleep, there is a doctor out there providing aid to the sick. There is a doctor spending the last few minutes of life with a dying person and their loved ones. I checked the patient’s bracelet for her name, listened for a heartbeat, checked for a pulse and observed for spontaneous respirations. I stepped out of the room, looked down at my watch, and called her time of death.

In loving memory of my patient. Thank you for allowing me the honor to spend your last few minutes of earth together.

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