During our seven-week clinical placement, we were given the opportunity to deliver care to COVID patients in the intensive treatment unit (ITU) at the peak of a wave. At first, we were scared of infection and what to expect. Then a fraction of doubt entered our minds: how could we, as medical students, be useful to the clinical team?
Thankfully, the reality was better than what we’d anticipated. After receiving training in manual handling, proning patients (to improve oxygenation) and basic PPE etiquette, we were ready to begin and quickly found ourselves integrating with the team. Being able to actively participate in nursing care helped us gain a deeper insight into personalised in-patient care, especially during COVID, where patients in the ITU present with different abilities and varying levels of dependence.
A first for everything
During our time in the ITU, one of us was asked to hold an iPad for a patient to say their last goodbye to their family. It was deeply emotional to be present in this family’s grieving process, observing both the patient, who had their medications withdrawn and was approaching their final moments of life, and their family’s reactions.
To some extent, our views and attitudes toward death are largely shaped by our own personal experiences, so watching this family’s grieving process, albeit through digital means, was incredibly moving and overwhelming – both personally and as medical students.
We’d recently covered moral distress in our ethics class. Learning about this helped us see how the clinical team were constantly affected by decisions that were largely out of their control, particularly ethical decisions regarding withdrawal of treatment when it was proving to be futile.
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Although as medical students we were excused from these difficult clinical decision-making conversations, we saw the exchange of opinions between different members of the multidisciplinary team trying to come to the most ethical decision possible. However, there was never a win-win situation, and ultimately one party was bound to leave accumulating more moral distress.
No one, and nothing, can prepare you for the moment you witness a patient die for the first time. We’re taught about death from an objective point of view: learning about the five stages of grief for the family. However, dealing with the emotions as a clinician isn’t something that’s covered effectively in the medical curriculum, particularly when it comes to students’ active involvement in the process.
We’d like to see additional training and support to assist students who witness death for the first time – particularly on clinical placements, where everyone is likely to take a subjective approach to losing a patient. This could be incorporated into modules focusing on clinical communication and topics regarding death and bereavement.
Luckily, we had regular debriefing sessions with our teaching fellow at the hospital, where we shared and reflected on our experiences in the ITU. They were very supportive and made sure that we felt ready to continue with the voluntary role.
No one, and nothing, can prepare you for the moment you witness a patient die for the first time.
After this eye-opening week, we returned to our normal specialty attachments. Our experience in the ITU highlighted to us the widespread prevalence of moral distress among healthcare professionals. Witnessing this phenomenon as ‘outsiders’ made us wonder how much worse clinicians, who face this daily, must feel. It also made us question the way sensitive topics such as death and grief are taught within the medical curriculum. Is it merely enough to listen to a lecture about this topic?
Conversely, this experience not only increased our confidence in interacting with patients and performing basic procedures on them, but also equipped us with better interpersonal skills.
We adapted to the role of ward support workers during one of the hardest times for the healthcare profession and engaged in this experiential learning process while assisting the clinical team. It made us realise there are always ways for us to contribute during times of struggle; it’s only a matter of willingness and determination. This truly was an off-the-books learning experience. We encourage all students to take up opportunities that temporarily drive them away from the conventional role of the medical student to view the clinical team from a different perspective.
Thankfully, the university’s wellbeing team has been readily available to support us and other students during this time. There’s a huge amount of support available to help students process their experiences on clinical placements and look after their future wellbeing.
One of the best sources of support are other medical students and your hospital teaching fellows because they will most likely have similar experiences. We’d strongly recommend regularly reflecting on your clinical experiences, either alone or with your colleagues. Acknowledging these difficult situations is often the first step to compartmentalise your experiences and learn to cope with them healthily.
No one should have to, or need to, take this on alone.
Students can access the MDU’s health and wellbeing hub for support at any time.
Meenakshi is a fourth-year medical student at Imperial College London currently undertaking an intercalated BSc in management. Her interests include sustainability, green healthcare and preventative medicine. When she is not studying, she enjoys listening to podcasts, spending time outdoors and learning languages.
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Daniel is a fourth-year medical student at Imperial College London. He is currently intercalating in surgical design technology and innovation BSc. He is passionate about artificial intelligence and machine learning in medicine and hopes to incorporate the use of technologies in his future practice as a doctor. Outside of studying, he enjoys cooking as well as playing snooker at a competitive level.
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