During my preceptor experience yesterday, I watched for the first time as someone died in front of me. A man in his mid-50's had a heart attack. He got CPR right away, even before the paramedics arrived at the scene, but he flat-lined soon after arriving at the ER 20-30 minutes later.
In these situations, the medical students are usually told to stand by in case the team needs CPR relief. This man didn't make it that far, though. I watched as the emergency team did their thing, trying my best not to get in the way. Then, before I knew it, the attending physician called time of death, and the entire operation was shut down.
I looked at the man on the table, who was now just a body to all the doctors and nurses and techs in the room. His eyes were partly open, and he still wore a bling watch on his left wrist, as if time still mattered to him. I wondered what he experienced, if anything, in those last few moments before the doctors decided that he could not be saved. If he had survived, would he have reported some sort of near-death experience like walking toward a bright light or talking to a dead relative? That would be too Hollywood.
I asked another doctor, after all the excitement had passed, why his death was so quickly called. Her answer was that we have to weigh the morbidities for someone who has been down for almost a half-hour. Even if they had been able to re-establish a heartbeat, it's likely that this man would have suffered severe brain damage, possibly to the point of persisting in a vegetative state.
In my training to become a doctor, I am certain to witness death again. It is inescapable, because Life is the currency of the profession that I chose.
Hey Bro,
ReplyDeleteThats rough man. I hope ur not too shaken by the experience. It does open your eyes. Its real.
Ive been there once and only once. I was a candy striper at Alvarado Hospital (near SDSU) working my regular volunteer shift from 10PM-3AM. Around 1am, a black woman was wheeled in on a gurney. She was a long-time dialysis patient and had acute symptoms of renal failure. They gave her bed 5, and I set up the room for the doctors. About 45 minutes later, I stopped by and noticed her vitals were dropping. Then, just like that she flat lined. I yelled "code blue!", ran and grabbed the triage nurse who then sprinted over there, me following close behind. He started yelling at her to wake up, and slapped her several times in the face to wake up. Nothing worked. The ER doc grabbed the code blue kit and the ER tech and started doing CPR. The tech then gave me the bag valve and mask and told me to squeeze fast while he set up the AED. The nurse was doing compressions. The doctor was preparing the epinephrine. I kept squeezing until he yelled "clear!". The doctor then injected her with epi. Another nurse entered and took over squeezing the bag valve while I watched nervously. They shocked her 4 or 5 times and injected her 6 times with epinephrine. I started massaging her hand, nothing happened. I poked her wrist looking for a pulse. Nothing was there. The doctor noticed me and my state. He told me to run to the pharmacy and get a vile of magnesium stat. They didnt need magnesium, they wanted me out. When i returned she was gone. They had already called it and wheeled her out of the room. The triage nurse was still closing the curtains and preparing for the next patient. He said that she was still in the room. He could feel her soul's presence. I could too. It was an erie feeling. Later the doctor came into the break room and said that death was part of medicine. I will never forget his words. "Many people have died so that I could learn. They have given their lives so that we can save others." He said other stuff too, but I cant remember.
Anyway, being a doctor is intense. Keep writing :)
Thanks for the story, Dave. It's definitely intense. I respect the gravity of what I observe and experience, but I don't let it phase me. It may seem crass, but experiences like this *are* part of my education - essential to the process of transforming me into a doctor so that I can apply those experiences to help other people.
ReplyDelete