DEATH NOTIFICATION | Huma Farid
My 9:30 a.m. patient did not keep her appointment. In a selfish desire for reprieve, I felt momentarily relieved. School drop-off had made me late that morning and faced with a surplus of 25 patients crammed into 15-minute slots, I now had a chance to catch up. After all, I reasoned, the visit was a routine follow up. I scrolled through my last note; she had struggled with secondary infertility for years but had finally conceived spontaneously with her youngest child. She had brought her daughter to the visit with me; the child stood close to her mother, silently appraising all the trappings of a doctor’s office. The patient herself was kind and soft-spoken and at the end of our initial visit, I recommended she return in three months for follow-up.
Today, at the three-month mark, the patient was absent. A sense of unease tickled my mind. Although this patient had only recently established care with the practice, I knew her to be punctual and responsible. She would have called to cancel the appointment. I rationalized the missed appointment—maybe she got sucked into the end-of-school events filling every parent’s schedule.
I would not have delved further except my medical assistant turned to me, distress on her face.
“There was an accident in the town next to where I live,” her voice trailed off.
She pulled up the local weekend news. A family of four had been driving to their son’s birthday party when they were hit by a drunk driver. The younger child had died on the scene, and the older child and mother were in critical condition at the hospital closest to the site of the accident, about an hour from where we worked. The article included only the family’s last name and the children’s gender and ages.
“Their last name is very common — there must be a hundred people with the same one,” my medical assistant reasoned. Then she hesitated. “I looked at the kids’ ages from your last note — same ages and gender as these kids.”
The best part of medicine is getting to know my patients. They are not a disease or a medical record number, but a whole human with a rich life that brings them joy and meaning. I try to capture a nugget of that in each note I write, as a reminder to myself to initiate every patient visit with a question about the most significant part of their lives. For many women, it's their children, and I always include a note about what those children are doing every year.
I did not want to believe the brief news report was the reason behind the missed appointment. A nauseating sense of guilt flooded me for earlier experiencing relief while my patient was fighting for her life and had just lost a child.
Every time I glanced at my schedule that day, my eyes fell to her name, and the unease I had managed to tamp down resurfaced. I wanted to believe so badly the article wasn’t about her. For the rest of the week, news reports provided no updates. My patient did not call to reschedule her appointment. That weekend, my nurse texted me an update from the local paper: my patient had died.
Death is no stranger to physicians. I was a fourth-year medical student completing my sub-internship in emergency medicine when I helped run a code for the first time: a young man, the same age as me, recently married, just like me. I did chest compressions while watching a flat red line on the monitor. He did not survive. I wept as I informed his wife of his death, her wail of grief cutting through me like a sickle. In my very first week of internship as an obstetrician gynecologist, we lost a patient to an amniotic fluid embolism.
Death remains present even in the happiest realms of medicine, like my field, where it is easy to forget the specter of death, because instances of it occur so rarely. Perhaps, as a result, the way death affects me has evolved over the course of my career.
When my first patient died in the ER, I collapsed on a chair behind the desk in the department, depleted by the physical and mental labor of participating in a code. With my head curled up on my knees, I wept and wondered how anyone could bear to see the next patient, knowing that the body of the one we couldn’t save lay on a cold metal gurney under bright white lights that highlighted the limits of our ability. The chief resident, recognizing my distress, sent me home. As I walked past the attending already sprinting to another emergency, I felt the full weight of my failure — failure to not save the patient compounded by my failure to take care of other patients.
Fifteen years later, I am now that attending. A resident and I delivered a patient with an intrauterine fetal demise. I did not cry. I went from that delivery to another. The responsibility of caring for another patient and being fully present for her birth inured me to grief. If I succumbed to grief in that moment, I could no longer fulfill my role for all the patients waiting for me to care for them.
So I acknowledged that grief, folded it into a corner of my mind, took a deep breath, and walked forward.
As an obstetrician, I bear the responsibility of shepherding my patients through the risks of pregnancy and childbirth. Part of our annual obstetrical emergency training is preparation for all contingencies, and that preparation has been ingrained in me each time I am on call. I know the deep loss my obstetric patients experience, having served as a witness to it far longer than I ever imagined as a new intern. I am rooted in it, aware of the burden of grief each loss carries, sure of my place to provide compassion and empathy and serve as another person to share that burden.
Yet I had never lost a patient in a manner so utterly random and devastating — someone with no risk factors, seeing me for a routine visit. This death unmoors me, and I find myself uncertain on how to respond. Do I reach out to the husband, who I met once? Would it feel insincere? Would I encumber him with meaningless condolences? Indecision paralyzes me. Days slip by, and I am consumed by the urgency of my own life and work. I feel the window of time to send a note of condolence snap shut. I am ashamed to admit — I do nothing at all to commemorate my patient’s passing.
It lingers in my mind, her passing and my own inadequate response to it. Faced with a death outside of the realm of my training, I blundered, unsettled and uncertain. I defer the death to process it later, because it didn't feel tangible to me. Childbirth is a risk factor I can understand, but this death, caused by human negligence, feels so freakish as to be impossible.
Months after her death, an Epic notification pops up in my In Basket informing me my patient was deceased. The death notification slices through my day, causing me to lose the threads of what I had been doing. The notification jolts tendrils of dismay through me even though I had known about her death for months. The awful finality unsettles me. My patient's death intrudes upon my thoughts, an unwelcome reminder of mortality.
Up until the death notification, I held a sliver of hope my patient would miraculously traipse in through the door, despite the news reports, having survived her hospital stay and recovered from the car crash. The death notification squashes all those hopes in a cold, clinical and terse fashion. I delete it almost immediately after reading it.
I return home that night to my family, safe, loved and present. I recall that first-ever death and how the weight of the grief nearly smothered me. I think about how this time around I struggled to feel grief, how I felt paralyzed by it, and how despite my attempts to pack it away, my patient’s memory resurfaced. Outside, on my porch, dusk outlines the branches in sharp shadows, the sapphire blue of the sky an unfathomable ocean. I am simply a speck in the infinite world around me.
I take a moment to honor all the death notifications.
Huma Farid is an obstetrician gynecologist in Massachusetts. Her work has appeared on Doximity, KevinMD, Harvard Health and Cognoscenti and in JAMA and Obstetrics and Gynecology. In 2024, she received the Media and Medicine Certificate at Harvard Medical School.