It’s around 9:00pm- I’m heading into the last two hours of my shift in the emergency department. I’m seeing an Amish patient who presented to the ED with neutropenic fever, when a trauma arrest gets called overhead. I excuse myself from the room and head over to the trauma bays. The large room is packed with people- EM, trauma surgery, multiple medical students from both services, nurses, techs, pharmacy, RT… Everyone knows what to do- this is a familiar routine for a busy level 1 trauma center in east Baltimore. When my senior resident arrives, he announces to the room: male, mid 30s, multiple GSWs (gun shot wounds) to the head and chest, CPR in progress, 10 minutes out.
Thus far in medical school up until my fourth year, I’ve seen plenty of trauma, many codes, and a few traumatic arrests. So far, I had managed to avoid doing chest compressions. I’ve done my fair share of compressions from my prior days in EMS, and I thought my days of futilely cracking ribs were behind me. But our EM attending asks for everyone without a defined role to step out into the hallway to give us a little breathing room. So I assign myself a role and line up first for compressions.
The patient arrives in a less than stately fashion, with a medic attempting to continue compressions, another struggling to ventilate via BVM, all while the rest of the EMS crew are hurtling the gurney and patient down the hallway. Controlled chaos begins. As with any traumatic code, there are people securing the airway, performing the primary and secondary surveys, doing compressions, and obtaining IV access- all occurring simultaneously. I’m attempting to provide high quality compressions while my hands are slipping all over the chest due to the liberally applied ultrasound gel, while nurses are applying the pacer/shock pads to the same area that I’m doing compressions, while a resident is making use of all that gel with a cardiac echo. We’re all fighting for the same real estate on the chest.
But we aren’t able to resuscitate him. No sign of spontaneous cardiac activity on echo. Time of death is called after 20 minutes, and we all de-gown, de-glove, and try to lower our catecholamine levels as we head back to our patients in the main ED. As I step outside the trauma bay, I overhear our social worker asking for the patient’s name from the sheriff so that she can contact the patient’s family. It’s clear from her reaction that this was not just another patient. This was someone she knew.
For the rest of the evening, I simply provided my presence for our dear social worker as she sobbed. I listened to her stories of how she helped raised her best friend’s son, who was now lying cold in one of our trauma bays. She shared the hardships and struggles that the patient had been through, and how he had grown into a fine young man. How great of a person his mother is, and how his mother is always there to help out all her neighbors. All his hit close to home.
Through my time in EMS, I had become well versed at dissociating from my emotions and focusing on the job at hand. Even so, I had learned to always take a brief moment to acknowledge the passing of a human life. I can’t pretend that witnessing such moments doesn’t affect me in any way. It is profound to stand at the cusp between life and death, to come face to face with one’s own mortality, and to witness the passing of a life, along with that life’s story. The patients that we take care of in the trauma bay come from all walks of life- young and old, rich and poor, of all ethnicities and backgrounds. Some are husbands/wives, sons/daughters, brothers/sisters, friends. Some have no next of kin at all.
But sometimes the most meaningful work we can do as physicians, especially when we reach the limits of our medical care, is to provide our presence. To let our patients and/or their families know that we are also fellow human beings. That we share in their joys, and share in their sufferings. That they are not alone in this world, even though their world just came crashing down around them. That we are there, that we are listening, and that we care.
That social worker later called me an angel and asked me who I was, how could I be so kind. I was taken aback because I wasn’t doing anything extraordinary. I was just being a fellow human, sharing in sorrow and mourning in grief. We all lose people that we care about. Death doesn’t discriminate. But helping someone along on the path towards resilience can be meaningful. As an ER doc, I’ll be there at those crucial moments in time. Delivering bad news is within our job description. But sometimes I’ll have nothing greater to offer than my presence as a fellow human being.