Dan and I mimicked ducklings as we followed our senior resident, Tassia, single file down the stairs on our way back to the resident room. As we neared the bottom, we crossed paths with another medicine resident leading two medical students playing the same roles as Dan and I.
“She died,” said the resident to Tassia.
“Wait, the constipation patient?”
“Yeah!”
“Oh my god, that’s terrible, but she didn’t even look bad. Well, she looked bad, but not that bad.”
“Yeah, right?”
There was a brief moment of silence as the four of us looked at our respective residents for cues on how to proceed.
Then the other resident broke the silence, “I just feel bad because we were joking about what if she died from constipation.”
. . .
Upon returning to the med student lounge, Dan and I had to ask Amy and Leika what had happened. Leika had briefly seen the patient that morning on rounds and heard her screaming while Amy was performing a manual rectal disimpaction. Amy had obviously had a more hands-on experience with the patient. As Amy recounted the story, a mental chuckle flitted through my thoughts, despite the darkness surrounding the situation. It reminded me of an M&M on my surgery rotation. A surgeon would make a joke about the case, and the room would roar with laughter. I couldn’t imagine the look of horror on the face of someone from the general public if she had seen that. But that’s how death was in the hospital: normal. I told the other three med students how I had yet to see a death. Yet.
. . .
Several days later, my on-call residents, Molly and Tassia, were admitting several patients when a code blared over the speaker system. They leapt into action as if performing a choreographed dance. We quickly ascended five flights of stairs, revealing the severity of the situation and the embarrassing state of our physical fitness. The room was flooded with nurses, PAs and doctors by the time we arrived. Tassia quickly jumped in, leading the code and barking out orders. Approximately half the people present seemed actively involved. Intermittent shouts permeated the room.
“Still no pulse!”
“One minute till epi!”
“Next pulse check?”
And I stood there uselessly, watching as nurses took turns forcing the fullest extent of their being through locked elbows. As they heaved the weight of their body, focusing on the chest of the patient, I could see his abdomen undulating up and down in a ripple effect from the force transmitted through his chest. The elderly patient’s weathered skin almost looked like an animation as it was stretched right up to its breaking point, heave after heave, testing the structural integrity of his collagen. His lifeless head extended back, while an endotracheal tube protruded from his gaping mouth. As I scanned his body, all I noted was a below-knee amputation. Had he been in an accident? Was he a smoker? Was he a diabetic? I knew nothing about the man.
As the reality of the situation settled in, I noticed the other half of the room. The people standing motionless at the periphery, like an audience witnessing this “performance.” And then, after far too long, I finally noticed sobbing behind me. The wife of the patient, with her hands wrapped around her face, suppressed vehement weeping while her daughter wrapped a blanket around her shoulders. I watched as they slowly accepted the situation.
“I didn’t even get to say goodbye. I mean we’ve had a lot of close calls, but I thought we had at least a week left.”
The family was pocketed away, distinct from the objectivity pervading the rest of the room. As a nurse turned to leave the ongoing code, she stopped briefly in front of me to admire my tie. I felt uncomfortable accepting the compliment, a statement so trivial in comparison to the situation at hand.
“Can we have some bicarb!?”
“I need epi!”
“Calcium!”
One resident stood in the back, criticizing a nurse providing hydration. She was holding the bag of saline shoulder high and actively squeezing it.
“Why doesn’t she just hang it?” he said in a heckling tone.
“Finally,” he whispered with a chuckle when she hung it.
As I turned back to the family’s situation to appease my conscience, I decided to grab a box of tissues. It seemed as if they’d been ignored for 10 minutes — what must have felt like a torturous eternity to them. As I handed the box to the daughter, I noticed the wife already had a small box tucked between her legs. Nevertheless, the daughter accepted the extraneous box of tissues with such gratitude that I could only guess it was for the gift of being acknowledged. Moments passed, and then, as if to signal that humanity was not all lost, I overheard the residents preparing to update the family. Molly spoke briefly to the wife and daughter. After the update, the chaplain finally arrived to talk to the family.
“I was holding his hand, and then I knew he was gone.”
“How did you know, was it because he loosened his grip?”
“No, it wasn’t that. It’s just at one point I knew I wasn’t holding him anymore.”
After 30 minutes, the members of the code all backed away from the body. Nurses shook their arms to dissipate the stiffness built up from continuous cycle of compressions. Many looked up at the clock to note the time of death. Monitoring wires were all disconnected. The patient was extubated, and people began to clear the room. The performance was over.
I didn’t know how to feel at the time. To be honest, I didn’t feel much. I didn’t know the patient. All I was able to glean from his history was that he had congestive heart failure and idiopathic pulmonary fibrosis, had been in and out of the hospital for two months and had been recently admitted with sepsis and a pleural effusion. I wasn’t sure if medicine had already instilled the “normalcy” of death in me. Was I already numb?
As I followed Molly and Tassia back downstairs, they bumped into the resident who was criticizing the saline bag technique.
“Hey, look on the bright side, at least there’s one less patient on the list.”
He had answered my question. No.
Contributing Writer
Wayne State University School of Medicine
I'm a fourth year medical student in Detroit pursuing a longtime passion in oncology. Oncology presented itself to me as the perfect intersection of complex medicine, intense academia, and emotional challenges. And at the heart of all this, the love for treating the patient join these three facets. But the foil to this love is the darkness that cancer exudes. Like a black hole, the gravity that cancer carries with it further binds these aspects of oncology tighter. And in these moments, the difference between medical science and the art of medicine become evermore apparent. Raw emotions and difficult decisions present themselves relentlessly. And it's my goal to capture these nuances and complexities in writing to paint a picture of the human complex.