Palo Alto, California, United States
|University College Hospital, London: the outpatients’ waiting room and dispensary. Wood engraving, 1872. Credit: Wellcome Collection. CC BY|
It was the end of the week, the middle of the night, and the beginning of my ER shift. All was quiet, and I was studying at the nurses’ station, still riding the high of having just aced a cardiology exam that was widely regarded as one of the toughest at my medical school. After nearly a year, I still occasionally felt ambushed by flitting misgivings about my place in medicine . . . that perhaps I would somehow prove unfit for this most hallowed of callings.
But this recent success assured me that as long as I dedicated the time and effort, I would be properly rewarded. Everything had worked out the way it was supposed to. As I jotted notes in my notebook, I assumed that this was just how things would go.
A shrill siren pierced the air, heralding the imminent arrival of an ambulance. We had a four-minute heads-up, so I rushed down to Trauma Bay 1. The late hour of the night—or more accurately, the early hour of the morning—meant that we were operating with a skeleton crew: just me, an attending, and a couple of nurses. I stood next to Dr. Foley as we waited for the paramedics. He was an older man with whom I had shared a shift only once before, but I liked him. He was generous with his advice and did not condescend when he spoke with medical students.
He nudged me and remarked, “Never hold out hope that it’ll be a quiet night.”
The paramedics rushed in, pushing the stretcher. The patient was a woman in her early thirties with a history of moderate arrythmias, according to one of the EMTs. I knew, from having learned about it in class, what the next steps would be: IV access is established; the vitals monitor set up; a defibrillator brought in at the ready; and intubation equipment in position. We had learned all of this in school, yet as it happened around me, it felt like a blur.
Dr. Foley’s voice cut through the fog.
“Start compressions,” he said. It took me a second to realize he was speaking to me, as everyone else in the room was occupied.
I knew how to do this. Right? My mind spun. I placed the heel of my right hand on the patient’s sternum, then left hand on top of the right. It felt as if I was going to break her ribs, but I kept going, knowing that such an outcome was not unlikely, and that, even if I did, a broken rib was certainly preferable to brain damage or death.
It surprised me how taxing it was to perform CPR, yet I did not slow, did not think of stopping. I was soon overcome with the laser-sharp focus of being in the zone—a zone where the only feasible outcome was this woman’s heart starting to beat again. And I was almost there; I could feel it.
I was vaguely aware of the flutter of activity around me, almost as if it were the background of a portrait photograph. I saw reality through tunnel vision, and the only thing I was really aware of was this woman and my own movements as I tried to revive her. The sound of my breathing, in sync with my pumping, filled my ears. It might have been a few seconds that elapsed, or it could have been an eternity.
But then—I heard my name. Whoever was calling me would have to wait; I did not respond the first time, or the second.
“Henry. We’ve called it. There’s nothing else you can do.”
It was Dr. Foley. He put his hand on my shoulder, pulling me away from the patient. I looked at him. Nothing else that could be done? No, that was not possible—there was still plenty that could be done. Wasn’t there? He shook his head, as though he could hear my thoughts, a barely perceptible movement.
“It’s okay, you did your best,” he said.
I could not make sense of it. I felt like I was free-falling from the high place I had been earlier, that tremulous perch of confidence I had balanced on after getting a good grade on a test.
“Is this your first time?” he asked quietly.
I stared at him, not registering his words.
“The first time you’ve had a patient die on you?”
I think I nodded, my eyes flitting to the table where she still lay. Asleep. If I let my mind wander in that direction, I could easily envision her opening her eyes and sitting up.
“She’s gone,” Dr. Foley said. “And sometimes, despite our best efforts, there isn’t anything we can do about it.” He pulled my stethoscope from my coat pocket and placed it in my hands. I looked back at him, confused. “Go ahead,” he said. “Have a listen.”
Her skin was still warm. I looked at her face, expecting her to open her eyes. I pressed the stethoscope to her chest, instinctively expecting to hear the lub dub I had always heard.
But there was nothing.
And the silence was deafening, even as I moved the stethoscope around a little, certain that I just needed to place it in the right spot to hear that familiar rhythm. Dr. Foley watched me.
I draped the stethoscope around my neck and stood up unsteadily. Dr. Foley said something to me, something about getting used to it, but it was as if I was underwater; I could not make out a word of it. The room tilted and my stomach flipped as my mouth filled with saliva. I knew what was going to happen, and that I only had a few seconds to make it to the bathroom if I did not want to get sick in front of Dr. Foley, the nurses, and the patient. I lurched out of the room and down the hallway, making it just in time.
When I returned from the bathroom, everything had been cleaned up, put back in its place, and the body carted away. It was as if nothing had happened, like I had dreamed the past half an hour. The patient was gone. The night was quiet once more—was I just supposed to return to the nurses’ station and resume my studying?
I went back and sat down, looking at but not seeing the textbook in front of me. There were about twenty causes of sudden cardiac arrest listed within those pages, but nothing that would be able to answer the question cartwheeling through my mind: why couldn’t we save her?
I closed the book and put my notes away. The cardiology exam I had just passed with flying colors was nothing. The stark contrast between answering questions on a test and being in the moment, my hands on a dying person, trying to save them, was overwhelming. All the knowledge in the world is no insurance. I had been drawn to medicine by a deep intellectual interest in the mechanism of diseases. Yet tonight, for the first time, I had been brutally awakened to the absolute gravity of this profession.
There was a good a chance I would have spent the rest of my shift in a stupor, unable to wrap my mind around what I had just experienced, if a very intoxicated young man had not stumbled in, propped up by two friends, one on either side.
“Come on, Henry,” Dr. Foley said. “I could use your help here.”
I stood up on what felt like very shaky legs. Dr. Foley gave me an encouraging smile. “We’ve got a patient here, 21-year-old male, tried to give himself an enema . . .” Dr. Foley paused. “. . . with vodka.”
I blinked, unsure if I had heard him incorrectly. The tiniest of smiles might have touched the corners of his mouth, or maybe I imagined it, I don’t know. But he gave me a pat on the shoulder.
“Be ready for anything,” he said. “Because one minute you’ve got someone’s life in your hands, and the next . . . you’re dealing with this.”
Perhaps he knew that it was, in fact, a blessing in disguise to have this new patient here, because it forced me to set aside any thoughts I had about what just happened. The first rays of the morning sun were piercing through the hospital doors when my shift wrapped up.
HENRY BAIR is a medical student at Stanford University School of Medicine. He previously attended Rice University and graduated in 2017 with a Bachelor of Science in Biochemistry and a Bachelor of Arts in Medieval Studies. Born and raised in Taiwan, he is interested in cross-cultural communication in medicine as well as the intersections between medical care and literature. In addition, he is passionate about medical education, especially in end-of-life care and in improving the patient-physician relationship. He spends his spare time writing, painting, and playing the cello.