Jane was a nice woman, scarcely old, who was admitted for sepsis and pneumonia. But it was only after we intubated her that we heard from her oncologist the truly grim prognosis of her disease. We didn't do her any favors with intubation and the family made the decision to transfer to comfort care only. I handled this completely without my resident, getting the morphine set up, making her comfortable, extubating her, pulling all the extraneous lines, stopping the drips. After the nurse and I called the family back in, it wasn't much more than five minutes before I was pronouncing someone dead for the first time.
Two years of clinical rotations in medical school and I never saw anyone die. Now more of my patients are M&M subjects than any other intern's. That's not a particularly uplifting distinction to have. Thankfully, nothing I've done wrong contributed to their demise. But it doesn't do much for a mood already dulled by lack of sleep.