It was a night where I worked at a hospital that our group contracts care with. Rural, with mostly patients that are simple enough- sprinkled with those that are seriously hurt or sick. There are the ones the medics bring to us to do the best we can before we ship them off to our accepting hospital. This, however, does not happen that often.
It’s one doc and one mid-level. I am new- not very comfortable with medicine yet, but patients remain the same to me...I do this because I actually do appreciate the real trust they put into us. My curve is steep, my heart thuds every time I see someone that my “oh shit” bell goes off.
Tonight, this sort of patient stepped into Trauma Bay A. She was young, 60, and was just returning from a vacation with her family.
At a rest stop, she had a syncopal episode. She was brought to us to get “checked out”. Normally, this is easy enough. There were some abnormalities on her exam, plus some concerning lab changes. Decision was to admit her to our accepting hospital. A last test had to be done- the medics had been called to transfer her to our regional hospital.
Off to CT. She had an episode of angina, but nothing that nitro did not fix. She got back to us, and as I was helping our nursing staff get her onto her stretcher, she became limp, and unresponsive.
The code began. I was working with a young, impressive, compassionate doctor that evening, who ran that code calmly, with great finesse. Every procedure was accomplished first pass- intubation was complete within 60 sec with RSI in place, chest compressions began right away. We had a few moments where we thought we might have her. More epi, a femoral line, fluids full on, everything was done.
She had driven home from the family reunion with her sister. Her husband had left an hour or so earlier with their dog. They made it to the middle of the state, about half way home when this happened. The calls were made to her husband; he turned around and tried to get to her quickly.
My job at that moment became to get the rest of the unit to run- despite what was happening in Trauma A, there were 16 other patients that needed to be seen- several with chest pain, shortness of breath themselves. My horror and concern was pushed back- my job was to get the patients seen, test ordered, and interpreted, successfully treated, and correct disposition, be it an admit or discharge.
I spent as much time as I could with the family between patients, trying to explain what was happening. Is there anything worse than knowing that you will never see your life mate again? I knew that this man would never hold his wife again, never be able to look into her eyes or hold her in his arms. And I think he knew it too.
There is a look that a human has, it’s haunting. When they look into you, past your defenses, past your medical training, and into your heart, asking for you to tell them the truth. Its raw, and when you feel it, you know, you know that this person deserves your most honest, trained, truest self. At that point, I could not answer him with words, but only could hold him as he trembled and cried.
She had had several episodes during the vacation that were concerning to him- he was beating himself up that he had not made her get checked out. He told me about these, told me how she loved their dog, and how he loved her inbetween clinging onto me, sobbing.
The staff worked for well over an hour on this young patient. To no avail.
After an hour, the time of death was called. Nothing could have been done for her...all of that medicine, training, and collective wisdom left us with just our hearts raw, and damaged, all of us aching for this woman and her family.
I walked out of the hospital that night with the family who were beginning to gather. I met the grandkids, the family dog. The shock had not set in.
I got into my car, drove for a few miles and pulled over. And then, finally, miles away, allowed the night to pour over me.
