TONY: Just Her Time…

I’ve been trying to remember every piece of this for the last month but time, as it often does, has managed to wipe many of the details away.  I suppose the best way to bring you back with me would be to tell you about the images that I still see when I close my eyes and think of my second day on surgery:  I can hear the cacophony of the bells, whistles, horns, and sirens of each monitor in the ICU room; I can see the heart monitor and watch as the normal rhythm changes suddenly to a pattern of tombstones racing across the screen; I can feel every muscle in my body tiring as I start my sixth round of chest compressions; I can pull my sneaker off of the floor and wonder why I was stuck to the ground for a moment, then realize that the linoleum is covered with blood;  I can hear fluid sloshing around in her lungs and underneath her skin as I pound on her chest; I can see the look of defeat in the eyes of everyone in the room when resuscitation efforts are called off; and I can still sense the stillness in the air of the room in the moments before it all started.

This patient came into the ER the night before for a problem that required immediate surgical intervention.  The surgery was long and reasonably complicated, but the patient was stable when she came out.  She ended up passing away approximately 12 hours after she returned from the operating room.  Within those twelve hours, her blood pressure readings were dangerously low.  Clinically, however, she did not appear as if her BP could possibly be as low as the machines were indicating, so hours were spent replacing cuffs, inserting new lines, and insisting that the blood pressure that we continued to read on the monitors was incorrect.  As it turned out, the blood pressure was being read correctly the entire time.  Every resident and attending racked their brains that afternoon, knowing that something just wasn’t right, but not prepared to second guess their treatment.  After all was said and done, three residents and I sat in the silent room, the patient’s cold body lying on the bed before us, wondering aloud if anything could have been done differently.  Everyone agreed, or perhaps was forced by defeat to agree, that every other path of management would have lead to the same outcome.

I know that this woman was eulogized by somebody, somewhere later that week.  If I know eulogies, much was made of the tragedy of this young woman’s death, but the universal consolation was that it was simply ‘her time’.  Some being greater than us had decided that her life on this earth was over.  Simple, really.  But as you enter the medical field, those consolations start to feel more and more empty.  Was it simply this woman’s time?  Or did your action, or lack of action, your judgment call, your mistake force the hands of the clock?

Welcome to the real part of medical school, kids.