Death Of A Patient, A Father, A Husband
There are some things that even my poor memory holds onto tightly. The first time I had a patient “code” on me is one of those memories.
A “code,” in medical jargon, is the term for cardiac arrest, when the heart has stopped. The hospital’s overhead paging system will bellow “Code 99” or “Code Blue,” and any available doctors and nurses must rush to help resuscitate. If nothing else, they make for great slow-motion montages on television medical dramas.
I was a first-year resident at St. Vincents Hospital in Chelsea, New York. About three months in, I was put on the Coronary Care Unit nightshift for five weeks. I loved the reverse hours–it’s when my tendency towards vampire hours began. The CCU is where the heart patients are. When you are on nights, there is a sign-out at the start of your shift. You get a list of about 30 patients from the daytime residents whose patients you are taking over for the duration of the night. Sometimes you get to sleep a full night, sometimes you don’t get to sit or eat for the entire 12-hour shift.
That night, I came in to a list of 20-some-odd patients. One was highlighted in yellow.
“Mr. ‘Davis’ has been having very low blood pressures all day and we don’t know why,” the outgoing intern said to me hurriedly. He clearly had places to go. Or maybe he didn’t, but I still understood the urgency. After spending all day caring for people whose illnesses never follow the medical textbook, playing medical detective, it takes all your restraint not to bolt out the door at the end of the day.
The night was a quiet one, until, at about 2:00 AM, Mr. Davis’s blood pressure dropped precipitously and I received a page from the night nurse. I ordered a CAT scan to check on a complication that he’d had earlier that day.
As we were wheeling him on the stretcher down to Radiology, I saw my senior resident. Something inside compelled me to blurt out, “I have a bad feeling he’s going to code.”
My resident assured me that he’d run down if there was any problem. Not the least assured, I proceeded to take Mr. Davis to Radiology.
During the scan, from behind the glass, I kept watching Mr. Davis’s heart rate monitor. Ever so surely, it began to drop, from 80 beats per minute to 60, then to 40. As the number crept lower and lower, my hand, shaking, picked up the phone and dialed the operator. “I need a code 99 in CAT scan….”
No sooner were the words out of my mouth did I hear the call over the loudspeaker. (Later that night, my resident told me that as soon as he heard it, he screamed, “Reena!” and ran downstairs to help me. He must have known how petrified I’d be.)
And petrified I was. I’d been to a few codes, but starting your own code is different. Especially when a 110-pound girl is using all her force to thump on a 220-pound man’s chest, while simultaneously screaming at the CAT scan technologist to keep the flow of oxygen going to the patient by squeezing an ambu bag placed over the patient’s face. Tears flowed furiously down my face as I saw Mr. Davis’s eyes glaze over and take on a ghostly shade of grey.
One minute later, the entire code team arrived and took over. My resident took me by my hand and quietly rode the elevator up to the call room with me.
On my way to the call room, I saw Mr. Davis’s wife and daughter pacing outside his room, panic-stricken. His daughter was about my age, and I quickly ran through a checklist of emotions I imagined I would feel if I were in her place, if that were my dad downstairs. Fear, panic, fear, chest-crushing pain, suffocating breathlessness, fear, profound terror.
I felt weak, like a failure. I had no words of comfort for this petrified pair. In a medical school course called “Bedside Manners,” we are taught, in a rather perfunctory manner, that empathy is a skill we must acquire and hold tight to when dealing with patients and their families. At that moment, though, I knew the uncontrollable emotions I was experiencing wouldn’t assuage, but rather would only terrify. This was more than my failure to keep my patient alive. This was a turn for the worst taken by a father, by a husband. This was beyond me.
My resident told me he’d go speak with the family while I was to go rest in the call room. I wanted to show the family how sorry I was. I wanted them to know he was taken care of by people capable of empathy and emotion. But I was afraid I’d blubber like a little child.
Mr. Davis died a few minutes after I’d left the code, and I cried myself to sleep in the call room that night.
My mentor later spoke to me about how important it is to remember that these are human beings I’m treating, not simply “patients,” and that there’s no shame in feeling the urge to cry. Over the next few years, I can’t say that it got easier to break bad news to families, but I realized that I wasn’t failing anyone by allowing my emotions to flow. I have learned that’s it’s alright to show emotion, enough to show a family that I care. In fact, recently a patient remarked to her how she felt comforted by my tears of empathy.
At some point we all become the patient in surgery, the spouse in the waiting room, the child crippled with fear. It’s during these moments that we need human compassion, and wearing a white coat will never restrict me from showing just that.