White gloves on black skin. The fingers of my gloved hands still interlaced, still resting tensely over her sternum. Elbows still locked. Frozen in the position endlessly refined during CPR training. It turns out that blood flow is important for catheter angiography, which presents a challenge if your patient has no heartbeat. Has not had a heartbeat for 45 minutes. You cannot image without moving dye and you cannot image during forceful compressions. The patient had been transferred from another hospital and none of the doctors and nurses who had periodically injected epinephrine and faithfully followed orders from an automated defibrillator had had the privilege of ever seeing her smile. Or was it better that we had tried to save a complete stranger rather than a person we had known?
I am doing flashcards almost rhythmically, rocking my chair and thoughts to the lilting cadence. It’s early, and my fingers are curled around a steaming coffee. I move forward through the deck, slotting each pearl of information into my brain as best I can, until one prompt jolts me from my focused state.
I could see the scythe swinging from one eye to another / The Reaper hovered towards my room / Life had left me months ago, when I had first heard the news / Now I knew it would’ve been better, had I not left the womb
Have you ever had a sinking feeling in your stomach when you are about to tell something to a patient or family member that might change their life forever? I had that feeling before speaking to the wife of my patient, Mr. Smith. It had only been one day since Mr. Smith was first admitted to the inpatient unit but regardless of how long the interaction is with a patient and their loved ones, some news is always difficult to deliver.
Somehow I managed to complete a full year of clinical clerkships without bearing witness to a patient’s death. This seems like a marvelous and lucky thing, and it is for all the patients whose care I played a role in over the past year. However, this might not be such a great thing for me, as a future clinician. Medicine is two parts science and one part humanity. The science part can be read in journals and learned from books, but the humanity part is learned by experience.
a nightingale knows best. / her call comes forth / as the daylight dwindles, / and, listen… i hear her now.
In today’s America, it is well documented that each year, more of our GDP is being devoted to healthcare spending, and a disproportionate amount of that healthcare spending is towards end-of-life care. According to a 2013 report from The Medicare NewsGroup, Medicare spending reached about $554 billion in 2011. This was 21 percent of the total spent on health care in the US that year. About 28 percent of that $554 billion — $170 billion — was spent on patients’ last six months of life.
We stood in the shadows, a staggered line of nurses, students and surgeons in matching blue scrubs and masks. It was the middle of the night. Our tired bodies sagged against the walls, our bloodshot eyes dancing between the clock above and the gasping life below. A young man was dying in the operating room. He lay on the cutting table with his arms splayed wide, like a martyred saint stretched upon the cross.
The old woman with long silver hair sat in her wheelchair, feet propped slightly up, smiling toothless among her layers of wrinkles. She waited for me to speak, deferring her decades of matriarchy and adulthood to the stethoscope I wore so casually after just months of earnest experience. Indeed, it sat lightly on my neck today but heavily on my heart. A few more seconds passed, as I contemplated how exactly I wanted to discuss her test results and how exactly I would ask her to proceed.
There is a white ball of yarn that rests on the chair beside me. I drag the free end, extend the thread and wrap it around the knitting needle to begin my stitch. I think I’ll try to make a scarf until my husband tries to speak again.
This beating heart / Gave me a second start / It gave me a reason to be / To be me
The beginning of third year clerkships is an exciting time for medical students. The first step of my licensing exam was finally behind me and now I could focus on applying the knowledge into a clinical context. I had heard a lot of stories about the third year of medical school. Perhaps what stood out most were the reflections shared with me when people witnessed death for the first time. From full codes to hospice patients, something about death seemed to draw out the most intense emotions and thoughts that can change lives forever. Although I always try to do the best for my patients, I knew it was inevitable that I would come across death. I wondered what profound thoughts and reflections I would have when I experienced it for the first time. It wasn’t too long before I was called to do CPR in the emergency department and I found it did not play out as I expected.