“How do you say, ‘I killed somebody today’?”: An Interview with Gulchin A. Ergun

Posted on April 26, 2012 by

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Gulchin A. Ergun is a clinician educator, the clinical service chief of gastroenterology and the medical director of the Digestive Disease Department, Reflux Center and GI Physiology Lab at The Methodist Hospital in Houston, Texas. In “Twelve Breaths a Minute”—her first published essay—Ergun recalls her first experience, while working as an ICU intern, of being in charge at the time of a patient’s death. Her patient, the mother of an attending physician at the hospital, had suffered a catastrophic stroke, and the family requested that she be taken off the ventilator. Interview conducted by Jasmine Turner.

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You were really shaken by the experience you recount in the essay. Would you say that as you spend more time working in the medical field, you become emotionally desensitized to experiences like those?

It’s natural to become somewhat desensitized the more you deal with emotionally charged situations, especially when you’re dealing with death. There’s something about having a reverence for life. The first time you deal with having to let someone go and feeling like an active participant in that, you no longer feel the same way if you encounter it again. That change is powerful.

Has it gotten easier?

I guess the short answer is yes, but it doesn’t mean that I don’t think about it whenever it comes up. I obviously have become more skilled in dealing with it. I’m able to anticipate a family’s or the patient’s needs better. I feel like I’m better at talking about it. Also, it’s probably a little bit easier in terms of putting it out of my mind a little bit faster.

Would you say it’s important for healthcare workers to separate themselves from emotions while they’re on the job?

That’s too black-or-white. I think to do a good job—and what I mean by that is to be able to empathize with families and patients and other people dealing with death—you can’t be so separated. The only way you can do it well is by being able to put yourself in those shoes. But, by the same token, there has to be some kind of a distance so that you can do it effectively. If, every time, it is such a big deal—you can’t let go, and it’s so hard, or you’re crying, or whatever—you can’t be a good support for the people who need you. They’re the ones who are devastated.

It sounds like an important balance that you have to strike.

Yes. I would say that.

The piece contains so much detail, which makes the story seem really immediate. How did you go about recreating these scenes?

Number one, I remember it very well. Two, I think that hospitals haven’t changed very much. In terms of what happened, that scene is recreated almost every time you have to do this. I think the fact that that world hasn’t really changed very much made it easier to put myself in that situation to reimagine all those details.

In your piece, a respected doctor deals with the death of his mother. Does working in the medical field change the way people deal with death in their personal lives, or do you think it really is the same for everyone?

I think that there is a recognition of what people will be going through. You have this understanding of what’s going to happen; you can anticipate it. And you do picture what you have to deal with. I think that was why, in that family, it was much easier to say, “Okay, no, that’s not what she wanted, and we have to do this.” Everybody got assembled relatively quickly, and I think that the doctor was able to be a better comfort for his own siblings because he was able to tell them what was going to happen. But I don’t think that it makes losing someone any easier. They were still grief-stricken.

You say at the end of the piece that you were saddened by how you had been changed by the experience. I was hoping you might go into a little bit more detail about what you mean by that.

I would say that it probably falls on several levels. One is that you become just a little bit more separated from the tragedy of it. Bad things happen to people all the time, and so you become more separated from the fact that this is happening all the time, which is just part of getting used to it. The second thing is… That was the first time that I really experienced the immediacy of death in that way. And then, of course, there was feeling like I was responsible for it, which was also different. I think that you should never feel glib or take it in stride that somebody dies, and you may have had some kind of a role in it. I think you should retain that this is a huge thing that is happening to someone and to their family.

It must be difficult to have to deal with feeling responsible for what happens.

I think those challenges in medical education weren’t talked about. We didn’t talk about stuff like that in those days. You talked about it, maybe, with your close friend. You didn’t tell anybody outside of medicine, because I don’t think you really thought that they would understand. How do you say, “I killed somebody today”? Even though you didn’t, that’s kind of how you felt. I think that has improved in medical education, but it probably still is not where it could be. I think other services deal with it better. For example, spiritual services and chaplains, in terms of dealing with those emotions that go along with being a part of that experience. But in terms of the physicians—the actual people dealing with it—I still don’t think enough time is spent either in preparation or in allowing people to talk about it and actually dealing with the experience when it’s happening. It shouldn’t happen years later where you think about it and come to your own conclusions. I think people need to be allowed to vent and share, to know that they’re not alone.

So you think it’s not quite where it needs to be yet?

I don’t think so, but sadly, I’m not in that part of education anymore, so I don’t really know. Every school is different. I think that schools are clearly way better than they were before, but it’s probably not even done that same way now. For example, say you turn off the ventilator. That’s actually not done by the intern or the resident any more in most hospitals. Either a respiratory technician, a nurse or someone else would execute the order to do that. I think in a lot of teaching programs, at least where I was, it was actually the house staff that did it, and that also made it a little too close for comfort. That’s just a change in healthcare in general.

I’m wondering, do you think there’s any way that you can truly prepare someone for that?

No, I don’t think so. Maybe you could change some of the mechanical aspects of it. And there’s some niceties that are nice to tell the family in advance: I’m going to turn off the monitor, we’re going to take off all the electrodes, we’re going to turn this off, the beeping noises here, you guys can all sit over here. Maybe even tell them that the patient isn’t uncomfortable, but we give them something to make them comfortable. There’s a preparation. You’re preparing them, but you’re also preparing yourself because you know what’s going to happen. If you’ve never done it before, then you don’t know what to tell them. And not everybody is good at it! Some people still won’t tell them. I do think that for those big things, it’s only when you go through it that you really understand.

In the essay you faced an ethical dilemma. Now, having spent more time in the profession, do you think that it’s okay to end a life when the quality of life is very, very low?

Yes. I do. I guess the way that I would describe it is the quality of life is usually low because the basic things that a person should be able to do for themselves—whether it’s breathing or eating or having their heart function normally … When you can’t do that is when the quality disappears. So what you are doing when you let somebody go is only letting nature take its course. If they had been at home or something tragic had happened, they might not survive. So it’s not that you’re actually helping them along; it’s what would have happened anyway. I do feel a little stronger about it now than I did then, probably because I’ve seen so many people who have been in that situation, and you know, as a physician, they’re not going to survive. There’s no miracle that’s going to make that happen.

That’s tough.

Yes.

Is there anything that you wish was done differently in medicine when it comes to the process of death and dying, especially when there’s not much more that can be done for a person? Or do you think that it’s handled well?

I think it’s certainly improved. I’m personally a big fan of hospice. I think that has improved. Can there be even more improvement? Sure. When somebody is in an ICU, you’re not going to be unplugging them or moving them to hospice, that just can’t physically happen. I think what can be improved is always the discussion. I may be more comfortable talking about it because I happened to go through it as an intern. But I happen to see a lot of people when I’m covering other doctors, and those doctors may be in their 70s. They’ve not had a discussion with the families of somebody who’s really sick, or with the patient: “What do you want to do if you’re in this situation?” That’s horrible. I’m really good about that now.

There’s a lot of guilt that can be taken away from somebody if they’re following what somebody’s express wishes were. You don’t feel bad about that in the same way as when you don’t know what they wanted and you feel like you’re making the decision for them. It helps a lot, and I think that still can be improved because we see that all the time. Bringing up the dialogue is key. That was what was different about this family I talk about in “Twelve Breaths a Minute”: They had already had that dialogue. They were really just being compliant with her wishes.

I actually sent a copy to the book to the attending [physician], and it was interesting: He sent me a letter back and he said that he cried when he read the story, and that it brought him right back there. But that he wouldn’t have changed a thing.

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Jasmine Turner, an editorial assistant for Creative Nonfiction, is a junior at the University of Pittsburgh studying English nonfiction writing, political science and French.

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