1/20/2014

Innocence fades

In this business of hospital medicine there is an understanding that some people who walk into the ER might not leave the hospital. As residents, we are always aware of the possibility but our super hero mentality never wants to think that we have no chance of saving anyone. A particular patient in question was pretty sick & it got to the point where the team was becoming comfortable with the idea that this patient might not survive the night. So they call the code blue to the patient's bed and after about 30 minutes of attempts to bring the patient back the patient was pronounced dead.

With a veteran nursing staff who has seen this countless times & even myself having dealt with many similar situations over the past 2 years, it was more business as usual and we were going to go about our day because thats just the coping mechanism that many of us had. What made this situation different was seeing my medical student crying uncontrollably. I know the nursing staff and I was in more shock seeing the student's tears then we were that the patient passed away. I didn't even think to realize that this maybe my student's first encounter with participating in a code & ultimately seeing the efforts fail.

I can remember a time where seeing death actually moved me to similar emotions but unfortunately it doesn't anymore. I'm not sure if its a goal of medical training to desensitize us to death and the normal reactions that usually come from it but I can say that the way I deal with it now compared to when I first started class in med school has completely changed. Even as we were comforting the student phrases like "this happens a lot" & "that's a normal reaction" came out, which in hindsight is a terrible way to think about it but it's really the easiest way I know that is going to prepare them for a future in medicine where some live & some die.

1 comment:

  1. I was a critical care (ICU/ED) nurse in a major teaching hospital for about a hundred years before I segued into law as a legal nurse consultant. When I practiced clinically, I saw more than my share of death, whether it be a patient I came to know as I cared for them the ICU, patients who, when they awoke that morning, never thought their last stop on earth would be later that day in the ED, or patients (or visitors) I saw only because I was carrying the Code Call beeper. Death was there every day, no matter how diligently we railed against it. (I am so thankful, by the way, that we had a dedicated pedi ED and a dedicated pedi code team, so my interactions with dying children were mercifully few and far between.) I have had conversations with the families of ICU patients who want "everything" done for Grandma. I start these conversations with, "Do you know what "everything" means?" And I tell them. Beginning with the consequences of doing compressions on an osteoporotic sternum and ventilator dependence from a flail chest. Arms, upper chest, neck, and groins covered with deep purple bruises where we have attempted to create venous access. Chest tubes. Catheters in bellies, bladders, and brains; it matters not whether there is a natural orifice - we will create one. The slow leak of blood from - everywhere - as the body's normal clotting mechanisms go haywire into DIC. I have had my gloved hands inside of bodies trying to stem the tide of blood gushing from holes where holes should never be. I have seen limbs contorted into grotesque shapes as they bend in about six places (which, oddly enough, bothered me more than almost anything else I have ever seen in my career.) We carry the smell of burned flesh around in our nostrils for days, and with it the memory of the all-too-young man shivering from the burns all over his body. I cover him with sterile warmed blankets and will my hands to stop shaking so I can get his IV morphine started. We avoid paralyzing and intubating him for as long as possible because his mother is on her way in and he wants to be able to say goodbye to her. He talks to me about what he had dreamed for his life and tears run down my cheeks. I was finally able to stop crying when he died.

    We don't cry for those who have died. We cry for those whose suffering we cannot ease.

    Some might say that detachment is the only sane response to what we see and do every day. Being detached from the spectacle of death does not mean that we do not care, though. I think it means that we care enough to look beyond the gross, the absurd, the repulsive, in order to do everything within our meager powers to forestall death another day, and when we cannot, we recognize and appreciate the peace. We have shared the most intimate moment in life with this person, but we don't grieve because grieving belongs to those who knew the person in life. Instead, we go back and do it again without tears and without further deliberation because there is another patient waiting for us to care for and about her or him. Tricia

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