How Many Patients Have I Seen Die?

Recently someone asked me how many patients I have seen die.

I didn’t know.

I have never kept a list, but the question made me think.

I have been an emergency physician for more than fifteen years. I’ve probably cared for somewhere between 20,000 and 30,000 patients over my career. With numbers like that, even a small mortality rate becomes a staggering number. I have seen my share of deaths.

We often think of the emergency department as a place that fights death. Increasingly, I have come to see it as a place where many people come to die.

More and more, I care for patients with advanced directives who do not want CPR, intubation, or other life-prolonging interventions. They simply want to be comfortable. Many of them spend the final hours of their lives in the emergency department.

We see different kinds of death.

The expected deaths.

The patient with metastatic cancer.

The demented nursing home resident dying of sepsis.

Families gathered around the bed asking only that we keep their loved one comfortable.

These deaths are sad, but they feel like the natural end of a life.

The unexpected deaths.

The forty-year-old father who arrives pulseless after a massive heart attack.

The teenager involved in a rollover collision.

The patient who walked into the department talking and arrested twenty minutes later.

These are the ones that stay with you.

The pediatric deaths.

There is a reason every emergency physician remembers every pediatric death.

Thankfully, they are uncommon.

But they occupy a disproportionate amount of space in our memory.

I cannot recall most of the people I have watched die. Although, those early in my career remain crystal clear.

The first child I pronounced dead.

The first time I had to call a family and interrupt an ordinary day with the worst news they would ever receive.

Then something begins to change. It isn’t that you care any less. Your mind has to adapt.

If every death carried the emotional weight of the first one, few of us could survive a career in emergency medicine.

You learn to compartmentalize. You learn to clear the cache.

You pronounce the death. Speak with the family. Complete the paperwork. Then you pull yourself together and walk into the next room to treat an ankle sprain.

Over the last couple of years, I have adopted a small practice.

After an unsuccessful resuscitation, I ask everyone involved to pause for a moment of silence. We simply acknowledge that a human being has just died before dispersing back into the chaos of the department.

It only takes a few seconds. Combined with a team debrief when appropriate, I think it offers all of us a little closure.

The ones you remember

Most deaths eventually leave my active memory once the paperwork is complete.

Not because they weren’t important. Simply because I played such a small part in that person’s life. We met only at the very end.

But some patients remain frozen in time. The first failed resuscitation I witnessed as a medical student. The patient who reminded me of my sister. The patient who reminded me of myself.

Years later, I can still picture their faces and remember every detail of the resuscitation.

Death isn’t what changes you. Repetition is.

With enough exposure, death loses its novelty. But it never loses its significance.

I am no more comfortable with my own mortality than when I started.

But I have developed a profound respect for how fragile life really is.

So how many patients have I seen die?

I still don’t know.

Hundreds. Maybe more.

The number isn’t what matters. What matters are the handful who have taken up permanent residence in my memory.

The ones who remind me that no matter how routine death becomes in the emergency department...

It never becomes normal.

ROSC.blog