He came in via EMS.
He was supposed to be a direct admit.
He was 29. This is extremely young.
The ER’s a place where you see things no one ever normally sees.
I often see people on the worst day of their lives; sometimes, those people aren’t even the patients.
His heart stopped beating about three minutes before arriving at the hospital, thus I had very little time to prepare before we began our assault against whatever it was stripping away this young man’s life.
Since he was transported from another facility, he already had IV lines and strong medications running already to raise his paltry blood pressure. The patient was already intubated. This did little to encourage me, since a patient who is intubated and on a norepinephrine and vasopressin drip has zero reserve.
We continued CPR. The EMS in my area is outstanding. They had quickly recognized the severity of the patient and started treatment even before his vital signs had plummeted.
We continued CPR. We gave epinephrine, bicarb, calcium, fluids and everything we could think to give to save this young man’s life. My partner came in and assisted. I called the ICU doc and quickly discussed. We got a heartbeat back. Briefly. The family was in transit. We lost the heartbeat.
We continued CRP. More epinephrine and a pulse came back again. I threw in a central line to start an epi drip. I did a quick bedside ultrasound. I saw the heart struggling and beating, albeit ineffectively. The pulse slowed again.
We continued CPR. There’s no way I’m stopping CPR in a 29 year old until the change of him making it are 0%. The family arrived and I quickly spoke with them, and they joined us in the trauma room. They watched us as we…
Continued CRP. I again checked with the ultrasound. The heart was not moving. We gave yet another amp of epi. We continued chest compressions. We did another round. We continued breathing for the patient. Another round. I knew where this was going but I didn’t want to face it. Please let this not happen. The family in the room watched as I rechecked yet again. I stood back.
Ten impossibly long seconds passed. We’d given our all. We’d done all we could. Nothing more could be done.
Then I called the time of death.
The immediate howl of anguish cut me to my core. It sounds cliche, doesn’t it? It’s the truth. I offered my condolences while the family wailed inconsolably. I left the room still filled with the energy and chaos of the code.
I sat at the nursing station.
I took a deep breath.
And I cried.
Several team members gave me support and hugs and well meaning words.
Should I have left? Maybe.
I’m the doctor.
I’m supposed to be bulletproof.
I’m supposed to always be professional.
I’m supposed to be the leader that never to breaks down.
Well, truth be told, it didn’t hit me until I had done all that could be done. Then the avalanche of emotion landed.
Maybe it’s good to let others see you break. Let others know that it hits the leader just as hard as it hits them, possibly harder. I know the nurses and PA’s and NP’s and techs are torn apart as well.
A few minutes later, I was collected, and I told the secretary to page the medical examiner. I still had a shift to finish, but allowing myself to mourn for just a few minutes was just what I needed.
That, and maybe sharing the story.
I don’t bad for crying.
I feel bad for the person who walks out of that room, and can’t.
Viral pic of an ER doc in Southern California after pronouncing a 19 y/o. (click for his story)
I know how that feels, friend, I know how that feels.