It all started out like this...
“Code! Code!,” someone screamed even before he was through the double swing doors of the critical care area of the ER I was manning about a week ago. The orderlies and triage nurse rushed through the doors pushing in a stretcher containing the limp body of a young man. As we’re programmed to do, we started resuscitation on the patient. While the code team was pounding away at his chest and continued to give life-saving medication through his vein, I had started the interview with the family to document what had led to the patient’s present condition. It was then that I realized that the patient was vaguely familiar to me. The patient was in his early twenties and he’d been in and out of the hospital for a hematologic malignancy. He’d undergone chemotherapy and radiation but remained sick. The latest development, and this I only found out that night, was that the cancer had already spread to his brain and the tumor wasn’t responding to radiation. I never knew the patient personally and had only seen him once or twice, but his name was familiar.
After about an hour of resuscitation, we had explained to the family that continued resuscitation efforts will be futile. The father was trying to compose himself but had agreed to stop the code. It was over, confirmed by the flat green line on the cardiac monitor. The nurses and orderlies started turning off drips and unplugging equipment. The lifeless body of the young man was perfunctorily cleaned and wrapped in a shroud, in preparation for the morgue. This scenario is not unusual at the ER and it happens almost everyday in the hospital. I was used to it. Just another day at work. It was a sad day to be sure, but just another day all the same.
This morning, some Facebook messages reminded me about that patient. Some of the floor nurses that had been friends with the young man had posted their goodbyes on their closed Facebook group. This piqued my interest and that’s when I started my google search.
The patient was an athlete and a student. I found pictures of him horsing around with friends, a genuine smile on his lips. One photo was of the patient with another friend, in sepia, both of them wearing barongs and looking up smiling at the camera. The pictures were accompanied by a blog entry by one of the patient’s close friends and through it, I caught a glimpse of a vibrant young man, about to begin his adventure in the world. In the article, the friend reminisced about their 9 years of friendship and lamented that he had lost a brother.
After one has done countless of codes and resuscitations, after many failed intubations and seemingly intractable arrhythmias, after handling the patient with stubborn low blood pressure that just wouldn’t go up after 5 vasopressors, it’s easy in Medicine to steel oneself from the realities entwined with one’s patient. It’s easy to detach oneself from all the drama and just focus on getting back a heartbeat or a breath, or even a continuous spike of electrical activity on the EKG. On some level, health care providers need to be removed from the emotion-laden realities of our patients so we can focus on the medical aspect, the main area we are called to address. We need to think and think quick. There is also the factor of seeing something too often that it becomes rote. Death and dying is such an integral part of the hospital, especially as a resident, and especially at the ER.
While each doctor and each health care provider will have a short list of memorable anecdotes about memorable patients, my google search reminded me that every single patient I see, whether at the ER, the floors, or outside the hospital, each one of them has a network of people who love them and will for certain be affected by any decision, wrong or right, I make in the patient’s behalf. In the hustle and bustle of the ER, such an obvious and instinctive thing can easily get lost, buried under piles of academic steel and medical jargon. My patient’s death reminded me that death is painful for those left behind and the grieving process for the family extends far beyond the confines of that little room I man in the ER. For us doctors, tomorrow means more patients to see and help get better. For my dead patient’s family, it means an empty bed and a quiet bedroom, a brother gone too soon, and one more grave to visit.
Sent from a BB.