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Aftershocks October 4, 2006

Posted by Benji in Journal.
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It was a morbid thought.  My classmate had informed me that 15 minutes after I had left the ER, a patient (who had previously walked in under her own power) died of a heart attack.  I wished I had been there.

“I don’t wish anyone harm,” my inner monologue quickly defended to itself, “but if someone is going to get sick, I want to be present and learn from that experience.”

I also had a certain distance from it all – both in terms of space and time.  When I was taking the emergency medicine elective myself last year, the last patient on my first shift came in without a pulse and, after a nurse, fellow student, and I attempted compressions without success, she was declared dead.  I had never known the woman alive, so it was hard to make the connect between cadaver and, well, mother.  Her back-story only made it worse: She had complained of chest pain during dinner, and though her adult-age daughters told her to go to the hospital, her husband (a physician) dismissed it as indigestion.  I vividly remember him standing against the cabinets in the trauma bay watching as his wife lay on the table, her body moving only under the force of chest compressions and a bag-valve mask.  Yet, as I learned in gross anatomy, the situation actually didn’t affect me that much if I kept my hands busy.  If I had a task to perform, my emotions couldn’t take over, and I could remain cool and collected.  The ER attending tried playing every card she had, including getting a radiograph of the heart even though the patient had been clinically dead for over three-fourths of an hour.  It was what I later called the “death dance” – choreographed movements that, at least in this circumstance, were just for show.

The last “show” was after the woman had been pronounced dead and the caregivers slowly walked away, peeling off their purple nitrile gloves.  The miscellany tubing and wires were removed from the woman, her hair was combed, and her hands were neatly folded atop a blanket that covered her nakedness.  Given how well I remember how the trauma bay was dressed up into a viewing room for a wake, I can’t even imagine how the scene was burned into the memory of her daughters.  They cried and threw themselves across the clean, white sheet that covered her.  I guess it did make sense – to present the best possible image for a last memory.  Somehow I expected the body to almost be abandoned like they show on “ER” – left alone in a dark room with gizmos still attached, a lifeless hand hanging off the table, palm-side up for effect.

Now, if entertainment doesn’t reflect life, then why is it a short segment from my time in the ER keeps playing?  The “stop” button is broken; “pause” provides only a short respite.  It’s been a little less than a year since I experienced death for the first time in medicine, and I feel like some of the scenes from that night are better fixed in my cerebellum than my experiences with death outside of medicine.  I recognize that death, as an observer, is something I have to experience.  So, in principle, I was interested to hear about my classmate’s experience with her first death in the ER.  It sounded markedly similar to mine, if not a little more intense: The attending brought her with him as he informed the family, and the attending himself had just returned from the funeral of his grandfather.  The student was also left to do a large part of the clean-up of the trauma bay after the team had failed to revive the patient.  And yet I was curious.

What keeps replaying, though, is not my own experience with death (those are mostly snapshots and discrete memories – points of metacognition), but my experience with life.  Within 12 hours of learning of my classmate’s experience, I was informed by another student (a former high school colleague and current Fourth-year) that a patient we had discussed in the ER had died soon after.

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