The electric doors opened. I walked through the passageway to the post-anesthesia care unit (PACU) with Zo, the other medical student on the service. Even at 12:30 a.m., the hallway was lined with people in purple scrubs: nurses, CNAs, and whoever else was staffed at that time. Chatter filled the usually quiet PACU. No beeping, just the light conversation of night shift.
Any time the electric doors opened, there would be silence. “False alarm!” someone would yell, and the chatter would resume. The electric doors opened again, but this time no one yelled.
A hospital bed rolled in. It was Marvin. His last walk. On rounds we would say, “Twenty-two-year-old with GSW (gunshot wound) to the head. Waiting for organ donation.” In the real world, that meant that Marvin had died by suicide.
He had succeeded, but only partially. He was brought in functionally brain-dead, but we had to wait for his brain to herniate to officially pronounce it. His organ donor status meant that we kept him alive until transplant. Finally, after a week of laying in the critical care unit waiting for organ harvest, he was here in the PACU.
Behind his bed, pushed by a nurse, was his family. Ten people. His mother was beside herself. The child she had raised, for whom she had weaved dreams of a wonderful life and whom she had protected from the world, was leaving her empty-handed. As Marvin’s family followed him to the door, their devastation was on display. No longer could they hide behind the curtain of his room or in the comfort of their home. There was nothing else they could do.
Tears filled the eyes of the bystanders. Empathy flowed freely in an area where nurses and doctors usually remained composed. Once the bed made it to the operating room door, each family member said their final goodbye. Marvin’s grandmother leaned over to kiss him. They were handing him over to the doctors and nurses — the vultures waiting for his organs to save another human life. Somehow, it still didn’t seem fair.
In the cold operating room (OR), I stood quietly hugging myself. The transplant surgeons stood at both sides of Marvin with the anesthesiologist at his head. For the first time since I began my surgery rotation, I knew for certain the patient wouldn’t leave the OR alive. Bryan, the transplant nurse, asked for a pause. The eulogy started. This time, I couldn’t hold my tears back. Suddenly, the 22-year-old with a GSW became a whole human — loving rock-and-roll, playing with his pets, and seemingly happy — rather than fragments on a piece of paper.
Unfortunately, there wasn’t much time to linger on my emotions at the loss of a patient and a human being. All too soon, it was time for the harvest.
Zo and I made our way to the head of the bed where I stood on a stool to get a better view of the operation. I witnessed the longest incision I had ever seen. He was exposed, his chest and abdomen just splayed apart. The medical student in me was in awe. The beating heart trembled in the surgeon’s hands: ventricular fibrillation. Over the next half hour, they continued to work on taking the heart out of his body.
Marvin remained alive. His brain had not been functional for a week now, but its remnants lay well hidden under the dressings over his head. Finally, the nurse introduced the infusion that would arrest Marvin’s heart. His blood pressure plummeted. Marvin was gone, and there was no time to waste or grieve. The heart now belonged to a 42-year-old man a couple states away.
Measurements and packaging of the heart finished quickly, and the cardiology transplant team left. The GI team continued to take out the liver and kidneys. Part of me felt exhilarated to see this miracle of medicine, but another part of me just wanted to pause and grapple with the loss of someone I had never spoken to. Finally, only the OR staff was left. We helped them put Marvin in a body bag for a forensic pathologist to examine; he was empty. I thought about his family; how empty they must feel without him.
At 4:45 a.m., we finally walked out of the OR. Placed on the outside of the door was his high school graduation picture. Both Zo and I stared at it. Marvin seemed so innocent and happy, but who knew the chaos that had stirred inside his soul. Silently, we walked through the halls to the call room. Despite the near 24-hour shift, I didn’t feel exhausted. All I felt was empty.
Marvin was my first patient to die and, in his death, he touched me in an inexplicable way. Maybe it was the loss of a life that could have been, maybe it was that I related to his struggle with mental illness, or maybe it was the inconsolable grief of a family. I’m still not quite sure. However, what I do know is that I will never forget him and that feeling: empty.