The other day I had a pre-med college student shadow me for a morning. Shadowing a physician has got to be one of the most boring things in the world. I mean, I walk around, I talk to people, I write in a chart, and I think. She gamely took a lot of notes and seemed really interested. I was struck by how idealistic she was about medicine, and sometimes she asked me questions that I’d long ago stopped asking.

Like, “How did it feel when your first patient died?”

My initial response was, truthfully told, “I honestly cannot remember the first patient I had that died. Most people who I see die are the elderly who are near the end of their lives, and in some ways it can feel natural. It’s hard when younger people die, those whose time isn’t really up.” I doubt I said it quite that well, but that was the sentiment.

Still, it bugged me not to remember the first patient I had who died. Then I remembered, not necessarily the first patient that died, but the one that affected me the most.

There was a young woman, J, in her late thirties, or perhaps early forties. She had woken up with a bit of a headache, sort of like her usual migraines, and not thought much of it. As the morning went on, the headache got worse and she went into see her primary care doctor. When she was there, he noticed that her face was droopy and she was slurring her words. He sent her into the emergency room, telling us that it was probably an atypical migraine. The CT scan showed a very different picture and by the time we went into see her, her entire right side was paralyzed, and she was terrified.

Her mother had died at a young age of a massive stroke, leaving J behind with her two sisters to be raised by a single father, not an easy thing in those (or any) times. She had recently started birth control pills, which unbeknownst to her had made her blood more likely to clot and caused the stroke. She likely had had an underlying blood disorder that made her blood more likely to clot alone, and the contraceptives just exacerbated it.

At that point in a stroke, it was too late for her to receive the potentially life-changing powerful blood thinner that can break up a clot–it is only given in the first three hours after the onset of a stroke, and J hadn’t sought medical attention immediately when her symptoms began as she quite reasonably didn’t even think of something like a stroke. At this point, there was nothing to do but admit her to the hospital and wait to see what happened.

Over the next few days, the extent of the stroke became clear. By the next day she was no longer able to speak coherently. Her husband, B, had been at her side the entire time she was in the emergency room, and now he returned with their three daughters. As the next day went by, J slipped further and further into a coma, and eventually was brain dead.

I remember the attending physician, the surgical resident, medical resident, and myself, at that time a third year medical student, huddling in the hallway outside of her room and looking at each other with grim faces, understanding that she was going to die. Everyone was monosyllabic in their sadness and sense of loss. The attendings were trying to decide who would go and speak to her husband. I remember asking, “Has anyone talked to him about organ donation?” The medicine attending looked at me and said, “That’s a good idea.”

I assisted the surgical resident in the macabre task of putting a central line (a large IV catheter) into J’s chest to continue delivering fluids and nutrition to keep her body alive until the transplant team could arrive. I don’t know exactly where all her organs went, but I know that she was able to donate her heart, kidneys, lungs, liver, skin, and possibly other things. Other than the massive stroke, she had been in excellent health.

The last memory I have is walking past the waiting room after the transplant team had come and gone, after J had died, seeing her husband in the waiting room holding their three daughters while his father-in-law watched over, not believing this most impossible repeating of history.

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