Sunday, 8 p.m. What started as valiant efforts of creating new recipes turned out to be embarrassing failures in judgment and common sense. Initially, I thought mixing tofu, some greens and pasta would turn out to be an Asian delicacy, maybe something that I could proudly share with friends and family. But, after adding one spice to another, topping sauce over sauce, I realized that it was over. It was time to call it an end, let the dish cool and graciously throw it away. As if that failure were not enough, I was up against my next enemy: baking “healthy cookies.”
The batter felt thick, so I added water; quickly the batter turned from cookie to cake consistency, and so there I was taking out my new cake pan and pouring what used to be cookie batter into it. Of course, as you would expect, the cake baked, hardened to rock, cooled and then found itself with the ashamed “Asian pasta” in the trash can. Life lesson: don’t add water to thick dough if you intend on baking it.
I stood there staring at the ruins of what remained from a bad day in the kitchen. I was irritated with myself, my poor decisions and my miscalculated predictions of ingredients. This was not the first time I was cooking or baking, and I just could not understand why things did not come together. Nonetheless, it was time for me to throw in the spoon and spatula and call it a night.
Monday, 8 a.m. Another day on the cardiology consult service. I finished pre-rounding on my patients, just had a few notes to finish. “We’re doing the right and left heart caths on Ms. J around 9 a.m., which you may want to join us for,” the fellow offered to me. This was my opportunity to stand behind a glass window and watch a catheter be passed into the femoral vein until we could finally visualize the beating heart in all of its beauty and grandiosity.
As I tiredly sulk into the cath lab, I hear the attending and patient laughing. “Your blood pressures have been consistently soft during your hospitalization, so complete sedation is not an option and any level of sedation would have to be carefully monitored,” the attending explained.
The patient laughed it off by responding, “Well, I hope I don’t feel too much!”
The site was prepped, and the right heart cath procedure began and then concluded within 20 minutes. “Everything is fine here. We’ve finished the right portion, now going to move to the left,” the physician explained.
“And everything is fine up here, Doctor! I wish I was more out for this procedure, but I’m doing fine,” the patient jokingly responded.
Then suddenly, within a blink of an eye the patient’s chest began heaving and her extremities flailing. The monitor quickly transitioned from normal sinus rhythm to a flat line. The fellow stepped back, and the attending stepped forward to begin chest compressions and yelled, “Call a code!”
The code team arrived, and within a few minutes the small cath lab became the scene of sheer chaos. It was an army of 11 medical professionals consisting of an attending, residents, nurses and technicians, who stormed in with this focused intensity projecting from their scrunched, serious faces. The attending on the code team quickly refocused everyone and gathered information on what had already been done. I stood in the back, providing information from the patient’s chart when asked. So far, chest compressions were started, one dose of epinephrine was administered and the defibrillator was charged and ready to go.
“All clear!” yelled the resident. A shock was delivered and compressions were resumed, but the monitor persistently showed a flat line. The guided execution of the ACLS steps continued, and the attendings began discussing causes of the patient’s rapid downfall. The conclusion: most likely anaphylactic shock secondary to intravenous dye.
After nearly 60 minutes of resuscitative efforts, time of death was called, and the code team left the cath lab. As they walked out seemingly undisturbed by the demise of our patient, they discussed who they were going to round on next, dinner plans and funny stories of family situations. I wondered what their thought processes were; they didn’t seem fazed at all. For that matter, I was pretty sure that my failed efforts at cooking and baking the previous night caused me more distress than their demeanors showed after the death of a human being. Was it years of experience and the desensitization that comes along with it? Was it the acquired skill of hiding your feelings that medical professionals are so well trained at? Was it the experience of distancing yourself from situations that are technically not in your control? Whatever it was, I knew that I was handling it much differently. After all, this was my first experience in a code amongst some of the most seasoned, experienced medical professionals.
I stood there holding the chart open to the page of family contacts which read, “Daughter: Call cell phone number.” The cardiology attending looked at me as I handed over the chart. I could see the disappointment and frustration in his eyes. The cath lab was his comfort area where for years he performed hundreds of catheterization procedures. But, it was now the site of an unfortunate passing of a life, an incident that he may never forget every time he steps into that cath lab. I imagined that he was asking the same questions I asked myself the night before during my baking failure: This wasn’t my first time, so what could have happened? Why did this happen? Where did I go wrong?
The major difference was I was dealing with failed cookie batter, and my attending was dealing with a human’s life and the daunting responsibility of calling family members. I walked over to the patient. Her body appeared exhausted after that hour of resuscitative efforts, her eyes were closed and the expression on her face was serene. My disappointment over cookie batter seemed so miniscule. On a larger scale, my disappointment over a few poor exam scores, the frustration over those long days during our clinical years, the bitterness over studying my youth years away in medical school were all insubstantial in front of what was lost that morning: a life that used to have love, happiness, family and friends.
As we walked out of the cath lab feeling defeated with our heads hanging down, the second year resident turned to me and asked, “So, do you have any questions?” I assumed he was asking me about the catheterization process or the steps of the ACLS protocol, all of which seemed irrelevant to me in that moment.
I simply shook my head, “No,” and continued to walk in silence. I knew that at that moment I needed to reflect; reflect on how transient and unexpected life and death can be, see life in a different perspective and appreciate what I have. Those moments of reflection seemed the best way to honor the patient’s life, and keep me sane.
Medical school many times feels like a race to the finish line; who can get to the end first with the most knowledge and skills acquired after years of relentless hard work. We are taught how to identify disease, how to treat it and how to prevent it. We are not taught, on the other hand, how to personally deal with the unfortunate wrath of human physiology in its deepest and darkest moments: death. I suppose it’s a self-learning process. For me, I feel that reflecting and putting our experiences into perspective help us cope and continue to preserve the humanistic aspect of the medical care we deliver. Understanding the why and how is crucial but so is protecting our sanity and the respect we have for our patients in both life and death.
If there is one thing I learned from that day, it is to honor–honor our patients, honor our efforts in making their lives better, honor our profession by never losing hope and honor ourselves by never giving up. That practice of not being so hard on ourselves and continually trying to do better begins with the small things in life.
I went home that evening and stepped into the kitchen to make dinner. It was time to pick up the spoon and spatula I had thrown the previous evening. It was time to try again.