A nurse looks over at the doctor, “It’s been 30 minutes now” she says. “Let’s go another 5” the doctor says as she watches me standing on a chair doing chest compressions on my patient, beads of sweat forming at my hairline. A paramedic motions for me to move so he could take over. My technique was starting to falter and I’m glad he noticed. “Rhythm check” a nurse calls out. The medic holds compressions. We all stare at the flat line on the monitor. The physician checks for a pulse. Nothing. “We need to call it” the doctor says, “time?”
I look down at my watch, “2123.” And that was it.
The asystolic rhythm strip was printed. The leads were unhooked. The monitors were turned off. One by one the room cleared out as the staff hurried off to their other sick patients, and I was left standing there with my last patient. My last patient of the night, and my last patient of my emergency medicine rotation. I felt I couldn’t walk out just yet so I started picking up the various needle and flush packaging that scattered the floor. I tucked in the sheet slowly and neatly and carefully around my last patient. A person who was now no longer a patient; who was now a body.
The line between life and death is so, so terribly fine sometimes.
My patient was young. Really too young for me to be standing next to his lifeless body. He was my age. He wasn’t sick. He didn’t have a terminal illness. He didn’t wake up that morning with a thought in his mind that today could perhaps his last day on earth.
He was a textbook case of a pulmonary embolism. One week post surgery. One-day history of calf swelling and pain. Started suddenly with shortness of breath, and called the EMS. On arrival he was tachypneic, tachycardic, diaphoretic and hypoxic. S1Q3T3 on his EKG. We noticed all the signs. We ordered the proper tests. We followed the treatment protocols. But my patient was still gone.
I couldn’t wrap my head around what just happened. Why when we did exactly what we were supposed to do, we still could not save his life. The physician explained to me that nothing else could have been done for him. That if the embolus is too large no amount of heparin will fix it. Even though he was intubated, the air in his lungs was not oxygenating his blood. You could see it in his blue lips. He would have never made it to surgery, because he coded right there in front of me. In school they teach you what to do. They teach you the algorithms and protocols. What they don’t really stress is that sometimes you will do exactly what you are supposed to do and it might not matter.
This patient hit me hard. I’ve seen people die before. I’ve wrapped up bodies in stark white sheets and brought them to the morgue. I’ve been standing there breathing the same air that they were taking their last breath in. But this was my patient. This was my first patient that died. I listened to his history, I did his physical exam. I told him to relax because we were going to take care of him. He was just talking to me. He asked me for ice chips. He asked me if I could go get his girlfriend in the waiting room. He asked me, and I couldn’t go because I couldn’t leave my patient. And I couldn’t find anyone else to go get her because everyone was so busy with other sick and dying patients. And now he’s dead and he wasn’t able to see her before he died. And she wasn’t able to see him alive one last time. That regret stabs a hole deep in my heart.
I walk out of the double hospital doors and feel the warm muggy Florida night air hit me. I get to my car and I feel my eyes tear up a little. One tries to escape but I don’t let it. It’s been a rough and stressful and beautiful and amazing 5 weeks. So many things I have seen and experienced during my rotation in the ER, I think it will take me a while to digest it all. I think about my patient’s sobbing girlfriend as the physician delivered the news. And I wonder what his plans were for the week. What was he like? Maybe he wanted to propose to his girlfriend soon. And I think about my own husband who’s been away from me for 6 weeks now. And how much my heart has been split into two. One half missing his presence in physical proximity to me, but the other half falling in love with being in the ER. I take a deep breath and think “fuck it” and I let one tear fall.
One little tear for a whole lot of reasons.
For not being able to grant my patient’s dying wish. For the fact that he was so young. For missing my family and friends I haven’t seen in 5 months. For missing my husband. For being thankful that even though he’s living 672 miles away, at least he’s breathing. For the patients you can’t save. For the patients who you could save but they don’t want to save themselves. For the joy I have in my heart for feeling so passionate about a job. For the fact that in 10 months I’ll finally have the career that I have been working towards and dreaming of for my whole life. I feel lucky and sad and perfect and pained all at the same time. My head and heart swirled in a sink of raw emotions.
You are a fabric of events and memories. Every new encounter is a new thread woven into what makes you who you are. I know I will have other patients who die. No, I will not cry about them all. With this kind of job there comes a sort of unfortunately advantageous desensitization. The horrible things we see over and over again are the lidocaine for our feelings. But every now and then a patient becomes a thread that is interwoven a little deeper into your fabric. And you remember for a moment that they are a person with a life just like you, not a constellation of symptoms to diagnose and treat.
I back out of the empty parking garage and say a little prayer for the ones we can’t save.
Want to hear what a typical day in my physician assistant emergency department rotation was like? Read about it here.
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