cardiac arrest

And now, as you breathe in.

Internship finished with an arrest.  A rip roaring drop-where-you’re-standing cardiac arrest.  One of our patients had been sick for a while, I’d seen her the evening before on an after hours shift and she looked so bad.  I did everything, documented everything, and then left when told by the med reg.  I didn’t get to make any decisions for her, and it’s not like many could be made.  The next day, eyes wide open, gasping for air, she just stopped.  Stopped breathing right in front of the poor nurse who was unfortunate enough to come into work on her birthday.  The rest runs like clockwork.  The nurse hits the panic button.  My consultant leaps out the door leaving my slightly confused reg and I standing in front of someone elses chest xray.  We cotton on, and follow, to find our boss doing CPR.  My reg takes over when he gets tired, I get a line in.  I take over from my reg.  I feel things crack under my hands.  I look at her face and I know.  We keep trying.  We all keep trying and about 5 different people rotate in and out while the head boss makes the decision.  “Enough guys”.    The nurse and I cover her up.  There’s nothing dignified about this but we try anyway.  Maybe more for ourselves than anything.

I clean up the various packets I’d ripped open in the melee, dispose of my sharps and suddenly don’t notice anyone else.  We go back to our round, everyone just goes back to work while the team leader calls the cops to go and find the patients husband – they were a poor couple and their phone had been disconnected.  He’d been by her side every day for her whole admission. No one says anything and for the first time I get it.  In medical school I’d seen similar things happen, I’d always been on the periphery, I’d watched everyone just get back to work and wondered at the heartlessness of it.

But it’s not heartless.  You’ve just watched someone die.  You’ve tried to bring them back, you’ve done all the right things for what they’re worth.  And you carry that with you all. day.  You’re too stunned, too defeated to cry.  And by the time the shock wears off, so has any tears.  You comfort the patients in the beds around her, still living, who witnessed the whole thing before the curtains were drawn.  Later her husband is there, saying he’s trying to be manly and not cry and in the same breath wondering why it’s okay to cry in public at the movies but not in public, for your wife?  But he can’t cry anyway, he can’t stop saying these things happen and desperately thanking us for trying and he should go because we must be busy.  He has no family and no friends.  We offer to call people for him, anyone, but he declines and again says we must be busy and leaves.  My heart breaks in half but I keep on working, keep on having Serious Conversations about antibiotic doses and yes I got that consult, I ordered those tests, I rang that person who knows what you need about patients x, y, and z.

I go home, I eat a lot of chocolate, and try to get her out of my head.  I lie awake all night thinking about her, about him, and their faces don’t go away that night.  Later it all fades and here I am at the end of internship and for the first time I think I know what it means to be a doctor.  It’s not about memorizing facts that may help you pass future exams and impress bosses with your so-called genius.  It’s about knowing what to do.  It’s about knowing how to fix you, how to use the best of what the scientific community has to offer to find a way to keep us all going.

I still don’t know where I’m headed.  I don’t really know what this all means.  Or how I’m supposed to feel about half the things I do and see.

At any rate, internship is over.  I have to take another breath in, because tomorrow it’s a whole new game.  Resident-only rotations, resident-only after hours shifts.  The really sick patient wards.  And for the first time, I don’t feel afraid.