In This Life

“Mom!  Mohhhhmmm!  MAMA!”

I’m on a deadline. I work the overnight shift tonight. And I’m presenting M&M at our staff meeting first thing in the morning. My powerpoint is nearly finished.

“WHAT, honey?”

“Well . . . what are you doing?” He’s rocking his head back and forth, something he has done out of comfort since he was a baby.

“I’m working on a presentation for work.”

“What’s it about?”

“It’s about a man who was very sick. He died. He had a heart attack. I have to talk about it with the other doctors.”

His head stops rocking. Maybe I shouldn’t have told him he died. Have I ever explained a heart attack? He looks into my face. Here it comes. How do I explain this to a six year old?

“Was he very special to the world?”

My breath catches.

On one of my last shifts of residency, lightning struck. Literally. A 19 year old girl. The room lit with activity as she was hoisted onto the stretcher in front of me, already intubated. I confirmed the placement of her endotracheal tube and called out the primary survey. Then I stood back and took in the scene. Trauma seniors doling out tasks, second year residents searching her body for wounds and shouting out their findings, nurses cross-talking over her body, adjusting IV lines and confirming medications — the embodiment of organized chaos.

In the middle of the room stood an undergraduate scribe, someone who signed up for this job to gain experience for her future aspirations in a medical career, someone who appeared younger than the patient. She frantically recorded the information being called out by the trauma leaders, while actively trying not to look at the body in front of her. I saw the discomfort and horror flash across her face when she did finally steal a glance. Following the direction of her stare, my own eyes now took in the girl before me, her exposed breast, jagged and partially avulsed where the lightning had struck, the flow of burns across her torso. The scribe’s reaction had suddenly made this patient a real person, a high school senior on a camping trip. Did her parents even know she was here?

After setting up the ventilator, two respiratory therapists laughed over the stunning agility of an eighty year old patient they had cared for on the inpatient floors who kept sliding through the bed rails and hiding underneath. Two nursing assistants talked about the score of a baseball game while casually rolling away the manual sphygmomanometer and thermometer stands. A nurse came in from the neighboring trauma room to raid the candy bag of another nurse and get a “one-liner” on this girl. Our indifference was horrifying. Was this what life in the emergency department does?

In the following weeks, I found myself going back to that moment and reliving the sharp edges of discomfort and embarrassment. Had four years of residency made me blind to the person in front of me? Fortunately summer came, with its distractions and non-clinical electives. By September, I had found a whole new focus — life as a new attending.

At my new job, almost a month went by without a code. Of course it happened on my first overnight shift, when I was single coverage. It was a new experience for me, running both the code and the airway with a skeleton crew of highly capable nighttime nurses. They deftly filled all of the roles that had previously required tag-teaming residents and a cadre of nurses and techs. I’m proud to say we pulled together as a team and gave it our all. Sadly the patient, like so many that arrive in cardiac arrest, died. But I had no sense of defeat. I spoke with the family, offering my condolences and, afterwards, my gratitude for the glimpse they gave me of this man who was so beloved. When I came back to the critical care room, everyone was busy cleaning up and prepping the body for the morgue. Chatter had already turned back to breakfast and life responsibilities beyond that emergency department shift, as if the dead patient didn’t exist. It wasn’t disrespectful, it was just the natural progression of things. Life moves on.

Was he very special to the world?

“I’m sure he was very special to the people who knew him, you know, his family and friends.”

“No. Was he one of the best people that ever lived?”

The intensity and innocence of his stare stuns me.

“I . . . I don’t know. He might have been. I didn’t know him.”

“Did mostly everyone else know him?”

“No. We’re talking about him because of how sick he was.”

“I’m really hungry for candy right now.”

So it goes, life in the emergency department.

I wholeheartedly appreciate the incredible teams that I work with in the emergency department. We go to work every day hoping to help people. As we do, we are often blind to the person in front of us, be it a nineteen year old girl struck by lightning or the most special man in the world. Occasionally, in the midst of the chaos, we are gifted with a random moment of clarity. In these moments, we become intimately aware of the magnitude of this life and the people we care for. We all have “those cases” that resonate with us regardless of how much time has passed. The memory of the patient suddenly comes to life, and with it, the emotions, too. And then there are times we simply go about our business.

And eat candy.

Because we’re hungry.

 

By Nadine Himelfarb

Nadine Himelfarb (@DinaHfarbMD) is an emergency medicine physician at Memorial Hospital of Rhode Island and a Clinical Instructor of Emergency Medicine at the Alpert Medical School of Brown University. A former high school classics teacher and mother of three beautiful boys, she is interested in medical education and thrilled to be a contributor to the growth of humanities in medicine.

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