Confessions of a medical student
Medical students are not prepared for the reality of working in a hospital with few resources and death a regular companion. Photo: Envato
I was 21 the first time a patient of mine died. It wasn't like
Grey's Anatomy
. There were no moments of silence, no beeping flatlines in the background and no weeping family members outside the door. It was cold and matter of fact.
The intern looked at me and said, 'There's a hundred more in the waiting room, so you better get moving.'
I didn't understand why no one seemed to care. I felt hopeless. The doctors moved mechanically to call the family. The nurses followed protocol. Ward work continued as usual. Someone added 'demise' to the whiteboard. Someone else shrugged, noting the patient had advanced HIV anyway.
Later, when I asked one of the doctors how they could move on so quickly, they explained it wasn't a lack of care — it was self-preservation. That was just the reality.
Healthcare workers don't deal with death, they separate themselves from it. This might seem heartless, but I think it is the only way they are able to go about their days. The beds and wards and passages are filled with death and sickness, and to not step away is to allow yourself to become enshrouded by it. Death becomes a part of the job, a cog in the machine.
Working in a public hospital with way too few resources punches you in the gut every day. It's not just the trauma of seeing your patient die — it's having no gloves in a delivery room; no alcohol swabs to clean wounds; and knowing that nurses stop at the shop on their way to work to buy their own gloves and masks because the clinic has run out. Where waiting times for a scan are months long and surgery delays needlessly let disease progress to the point of being inoperable. It's the limited beds in high care that mean doctors are regularly forced to decide whose life is worth saving more because there's only space for one.
As students, we're never truly prepared for this. We're expected to know all the theory. Every system. Every drug.
We deal with death as an academic topic. Our palliative care lectures teach us about prescribing morphine in the terminal stages of cancer, and we learn what happens when body tissue dies. But we never deal with how it feels
to spend every day in the face of death amidst a failing system.
No one teaches us how to navigate our own grief. No one prepares us to be resilient in the face of moral distress, to speak out from within a toxic hierarchy or how to balance this kind of work with life outside of the hospital. We aren't taught how to brush off the demeaning comments from seniors, or how to cope with feeling stupid on a ward round no matter how much extra reading you do.
It's funny — you think you know these things. After all, plenty of people have told you that medicine is difficult. Perhaps I should've listened more carefully. Medicine is difficult. But not in an abstract way. It's difficult in a very tangible, concrete way.
It demands enormous sacrifice. It chips away at you. It burns you out before you've even begun. It forces you to be constantly surrounded by suffering. It's hard because you know the system will never change and that it will be hard forever.
And yet, there are moments. Moments of humanity. Moments that remind me what a privilege it is to be where I am. In the middle of a rant about a hard day, my mom will reliably tell me how lucky I am to be a medical student. Usually, I find this frustrating and enraging. But deep down, I know she is right. How many twenty-somethings get to witness a baby's first breath? Or see the inside of a living body? Or watch a psychotic patient slowly regain clarity?
Last year, during my internal medicine rotation, I had a quiet night on call. I spent most of it with one patient, an elderly man admitted in a delirious state. He was confused for most of the night, but I had time so I stayed with him. I checked in on him often and chatted with him when I could.
In the morning, during the ward round, he told the senior doctor that I was the best doctor in the whole world. Of course, I was mortified, given that I was just a student. I hadn't done much at all (and besides he was still probably a little delirious). That patient will stay with me forever. He reminded me of the real value of being a healthcare practitioner. I didn't really treat him, but I made him feel cared for. And that made a difference.
But if I am honest, I hate medicine more often than not and cannot fathom spending more of my life doing this. At the same time, I am scared that I won't find anything else as meaningful; that if I don't continue and I don't use this power for good, I will feel like a phony. Perhaps I would be neglecting a better or more honourable version of myself if I chose to veer off. There's something incredible about being there for people in their most vulnerable moments. About witnessing life, death, survival, and everything in between.
That first patient death still sits with me. Not because it was dramatic, but because it wasn't. It was quiet, clinical, and cold. For the doctors, there just isn't time to feel everything when you're drowning in back-to-back patients and broken infrastructure. For me, a student, that loss was raw. I am not numb from the system yet, and whether it is a strength or weakness, I hope that I never become that.
So, I don't know what the future holds. I don't know if I'll stay in medicine, or find something else, or totally change paths.
I've considered taking business courses or trying out humanities. I've thought about doing a 180° and studying acting. There's always the chance that I could find my very own billionaire and be a happy house mom.
The doctors I speak to think I'm crazy for going through medical school without being sure I want to be a doctor. I'm sure my parents will worry that I'll land up being a complete flop.
What I do know is that this work has shaped me in ways I'm still trying to understand. And for all its chaos and pain, I feel lucky to have been a part of it — even if just for a little while.
Sarah Stein is a fifth year medical student at the University of Cape Town.
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