Recently, my thirteen year-old daughter did a school report on my job, focusing on the emergency room setting and what my role within all the chaos was. While we were in the emergency room touring and taking anonymous pictures for her power-point presentation, she found a new appreciation for what I did when a young knifing victim was brought in by ambulance.
Because my only purpose that day was to help her collect information and take pictures, I didn't go into the patient's room and obviously shielded her from any gore. She was mesmerized by all the commotion. We waited around until we received word that the eighteen year-old would be okay. I could see her exhale at the news and, in a moment of tenderness, look at me with saddened eyes. I could not have given her a clearer perspective of what I am sometimes called to treat.
During the drive home, she was quiet and affected. Slowly, though, I was able to pull her from her private thoughts and talk aloud about what she had seen.
"Dad," she asked thoughtfully, "what was the saddest patient you ever took care of?"
"Oh, honey," I said, "you don't really want to know that, do you?"
After a little more convincing, she had me scanning my brain for my most haunting "sad" cases, which I could count on way too many hands. In an odd way, I think as an ER doc you build a protective wall and tuck your memorable cases neatly behind it, adding it to the "sad" list, the "happy" list, the "traumatic" list, the "old-people" list, the "funny" list, the "you're never going to believe it" list--endless lists of cases that touch your essence.
Look at me, even now, protecting myself by calling these encounters "cases" and not "patients." Shame on me. But trust me, it's a big, big wall.
Anyway, her sweet voice brought me back to reality. "Please, Dad. Just tell me."
I decided to face down her request. She was thirteen and she was persistent. So I broke and shared with her one of my most heart-wrenching moments.
It had been one of those long, endless overnight shifts early in my career. There had been no time to breathe as one critical patient after another continued to present to the ER, even up until 6 a.m. We had just received word that an elderly gentleman who had presented to our ER with low blood pressure and severe abdominal pain (a quickly made diagnosis of a ruptured abdominal aortic aneurysm) had died "on the table" during surgery, this after transfusing him with six units of blood while waiting for the cardiovascular team to arrive.
My nursing staff and I were beaten up, unable to shake this moment of our failed heroics.
"Well, this night sure can't get any worse," Lisa, one of our best nurses, said. She should have known better. She had barely finished speaking before the prehospital radio sounded off.
An ambulance was bringing us a SIDS (sudden infant death syndrome) baby just discovered by her parents.
Our team was sullen and quiet as we waited in one of our resuscitation rooms for the ambulance's arrival. Within minutes, the paramedics rushed through the door carrying a lifeless little body, about eight months or so. Following them were two young, frantic parents carrying another living child of the same age. The SIDS baby was a twin. As our social worker took the living baby from dad's arms, my medical team and myself urgently examined the tiny patient lying on the cot, allowing the parents to stay in the room with us.
Sadly, it was too late. Death had visited this child hours before and we had no arsenal to reverse this devastating event. We later had learned through the paramedics that this family of four shared one mattress, tucked in the corner of a rundown studio apartment. When mom had rolled over during the night, she had discovered that her baby "felt cold."
When you "pronounce" a patient (declare their death and exact time of death) in the emergency room, at least two phone calls must be made--to the coroner, in case an investigation or autopsy is necessary, and to the family doctor. These are "must-dos" for me professionally, but are hardly the things I feel are necessary to begin a family's healing.
We sat the parents in rocking chairs and gave mom her little baby. We had the social worker bring in the other child and handed her to dad. I stood in the corner of the resuscitation room, lights dimmed, absorbing two parents with two children, one living and one dead, rocking slowly back and forth, enveloped in their grief. I had held their hands, shared their misery (as a parent, I was witnessing one of the most earth-shattering nightmares any parent could have), and had chosen my useless, sympathetic words carefully. There was but one thing left to do.
I went and found Lisa and asked her if we could please clip a few strands of the deceased infant's hair to give to the family. This was something I had learned from our pediatric trauma center during residency. It can be a vital part of a family's healing process. The hair was tangible, something to hold when a memory isn't sufficient, something to smell, something to touch with trembling fingers, something to press against a broken heart. If not now, a day would come when the family would be thankful to have this possession.
As Lisa and I quietly reentered the room, I will never, ever forget the scene that awaited us.
Mom was still holding the deceased twin while the living twin sat in dad's lap, her grasp within reach of her twin sister. Her hand was on her deceased sister's head, gently patting it, quietly twisting the dark strands around her fingers, almost as if urging her sister to wake up and play. The potency of this action--the playful innocence of her little hand wrapped in her dead sibling's hair--was a moment of both stunning serenity and infinite devastation that I will carry with me always.
I finished the story and looked over at my daughter, her big brown eyes fixed on my face.
"Dad," she asked quietly, "did you cry?"
"Honey," I said to her, choking up, "I still do."
My next post will be Wednesday, November 25. I promise it will light-hearted...