My first patient died. How I learned to forgive myself

On Match Day last week, more than 17,000 US medical students were offered their first jobs as doctors. Jennifer Adaeze Anyaegbunam was one of them, matching into her first choice, a psychiatry residency program at Cambridge Health Alliance. She reflects on the transition from medical student to doctor, and what it means to take responsibility for another individual’s health.

The first time I felt the full responsibility of being a doctor, I was a fourth-year medical student at the University of Virginia, walking around the outdoor track with a classmate.

A young woman ahead of us suddenly collapsed. Other runners and walkers began shouting for a doctor. My friend Sashka and I instinctively responded, recognizing that as fourth-year medical students, we were probably the next best thing. As we sprinted across the track, we realized we were the only thing.

I dropped to my knees and rubbed the woman’s back, hoping she would get up, dust off the humiliation of a fall, and continue her evening run. But she didn’t move or respond to our questions. I used my iPhone as a makeshift penlight and looked into her eyes. Her pupils were dilated and didn’t constrict in response to the light, a bad sign. Her lips were turning blue, she began gasping for air, and her pulse faded away.

Sashka and I rolled the woman onto her back in the choreographed motion we’d learned from physicians in the emergency room. I immediately started to do CPR. While I’d practiced this on a mannequin a few years earlier, I’d never done it on a human being whose life might depend on my doing it right, and I was relieved when paramedics arrived and took over.

As the ambulance drove away with our patient, I felt a mix of emotions — pride in my ability to remain calm under pressure and recall how to do CPR; excitement about the opportunity to help someone in need; and worry about the woman’s prognosis. But most of all, I felt disbelief. We had cared for someone in dire straits on our own.

“We just did all that unsupervised,” I kept repeating to my classmate. There was no experienced professional on the track to guide us and take over if needed, as often happens in medical school. Sashka and I were confident we had done the right thing, yet we also hoped we hadn’t somehow botched her care.

Two days later, I learned that the young woman, an undergraduate at the university with her own dreams of becoming a doctor, had died of an aneurysm — a blood vessel in her brain had burst, causing massive bleeding into her brain. The medical school’s deans assured Sashka and me that no one could have saved her life, and that the CPR we did let her fulfill her wish of being an organ donor — nine of her organs went to five people in need.

We were commended for our actions, but it was hard to hear congratulations for such a tragic outcome. I wondered, is this what it feels like to be a doctor?

As Atul Gawande writes, “You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. … It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve.”

After a decade of wanting to become a doctor, it was traumatic for me to witness the death of the first patient I cared for on my own. Medical students are trained to fight death, but I was unprepared for the gravity of having my hands on an individual in her last moments. Even knowing there was nothing I could have done to prevent her death, I felt like a failure.

That day on the track taught me a lesson I couldn’t have learned as a medical student sheltered by the protection of a supervisor. While we set the highest of standards for ourselves, the practice of medicine is imperfect and sometimes unpredictable. When we stop trying to make sense of our catastrophic collisions with loss, forgiveness — rather than failure — becomes the definitive teacher.

I returned to my comfortable role as a medical student, following residents and attending physicians around like a duckling follows its mother. When I start my residency this summer, though, I’ll be forced out of the nest and into the real world of medicine where these collisions are all too common. From day one of my training, I will share in the responsibility for patient care and gradually build enough competence to shoulder it on my own.

I will also start with an appreciation for “humility that embraces the intention and the effort, in spite of the outcome,” a lesson my medical school dean shared with me. Despite the many achievements I’ve needed to get this far, I am coming to understand that medicine is not always about succeeding, but it is always about trying.