It is late at night but you have no idea what time it is because you have been sitting in the Emergency Department for hours. You cannot even remember what time your shift started. Was it 8 or 9pm? Your stomach grumbles out loud but no one seems to hear. Everyone is consumed by patient records on their computers and no one seems to even get hungry. The packed snacks disappear though whenever you come back into the room. You ask the Doctor you are working with about the patient you have just seen. He dips his hand into his left pocket, pulls out a kit-kat, offers you one, and says it does not look great for her. You see, this is a 78 year old woman who had a heart attack 3 days ago but came in today because her chest pain would not get better. She tells me she was watching TV three days ago when she felt a sharp pang in her chest and subsequently her left arm went numb and felt painful. She thought maybe it was indigestion because she had something different to eat that day. She got a couple of Tums and continueed to watch her shows, not thinking twice whether this could be something worse. She is after all a generally healthy 78 year old only on three medications of which one is Vitamin D.
She comes into the Emergency Department via ambulance with unrelenting chest pain and says that she feels like she cannot breathe. We try to figure out what is going on and they come in and do a quick EKG (short for electrocardiogram) in order to see if she is having a heart attack. You are sitting in the room as the results of the EKG are being printed. The nurse hands you the EKG and even as a medical student you know that it looks off. You smile at the patient and tell her you will be right back. Your pace quickens as you search for the Doctor and when you finally see him, he can tell there is a look of alarm written all over your face. He stops what he is doing and follows your lead. You pull out the EKG and show him. A concerned look comes over his face and you realize this is one of those times you hoped maybe even wished that your interpretation of the EKG was incorrect. From your right, you hear the sound of an alarm go off in the direction that you just came from.
The Doctor looks over at you and gives you a questioning look wondering if it is possible that Mrs. A could have anything to do with the alarm that just went off. We rush over to Mrs. A’s room and see a crowd gathered inside and outside the room. The Doctor and I push through the crowd and see other Doctor’s already surrounding Mrs. A who are trying to figure out what is going on. I jump in line behind the nurse who is performing CPR and in two minutes it will be my turn to perform CPR. When the nurse in front of me finishes a two minute round of CPR I am up next to perform. You do not realize how tiring CPR can be especially when you are not a 6 foot guy. As I am performing CPR, one of the Doctor’s has figured out that there is blood surrounding the heart. All I can think is how did this happen in just a matter of a couple of minutes. I literally left Mrs. A just a couple of minutes ago and we were laughing about something. She was completely fine and yet in the span of literally 2-3 minutes she was now lying on this hospital bed in the Emergency Department being given CPR by a medical student.
Later while discussing Mrs. A with the Doctor, we talk about how the EKG showed the presence of a heart attack that occurred a couple of days ago. So what must have happened was she had yet another heart attack when I left her to go find the Doctor. Since she had a heart attack a couple of days ago it weakened her heart and then when she had another heart attack sitting in the Emergency Department the weakened part of her heart burst open and caused blood to accumulate around her heart. If this happens for too long it can cause the heart to not be able to pump blood to the rest of the body. This is exactly what happened to Mrs. A. By the time they figured there was blood around her heart, too much blood had accumulated, and even removing the blood was unable to do anything for Mrs. A.
I performed the last round of CPR for Mrs. A before they decided to stop and pronounce her dead. In the haste of the situation, the first round of nurses that came in actually redirected Mrs. A’s husband and daughter into the bathroom while the Doctor’s were attending to Mrs. A. As I stepped away from Mrs. A, my heart slowly shuddered because I remember that Mrs. A’s husband and daughter were just a couple of feet away in shock, fear, and anxiety listening to the medical terms being thrown out and not knowing what was going on. As Mrs. A’s husband and daughter stepped out of the bathroom all they saw was Mrs. A lying on the bed defeated. The look on Mrs. A’s husband’s face when he saw his wife lying lifeless was heartbreaking. He broke down right in front of the Doctor and I. He could not believe that she was gone. He knew this day would come but he never thought it would be so sudden. He always imagined a struggle towards death, never such a sudden drifting away of a person. He told me how she is the only woman he has ever been with since the age of 16. He had been with her for 62 years and cannot imagine a day without her.
As I walk away, the Doctor comes up to me and asks if I am okay and if I have ever seen a patient pass away. In an attempt to appear strong I tell him I am doing more than okay and have seen plenty of patients pass away. Little does he know that Mrs. A is the first patient to ever pass away in front of me. The Doctor gives me a pat on the back and thanks me for my help with the patient. I look up at the clock and see that there are still a couple of hours left in my shift and surprisingly I feel fine. I go to see other patients after the passing of Mrs. A and finally it is time to get ready to go home. It has been such a tiring night and I am ready to jump in my bed. As I am driving home I remember Mrs. A and her warm personality. I think of her being so full of life. I think of her laughing at a joke I said right before I left her room. I think of her husband and daughter sitting in the bathroom overhearing the noises just outside in the room. I think of her body lying motionless and it is my turn to break down. There is an overwhelming desire to cry and I have to pull over to clear my head. I sit right there on the side of the road paralyzed thinking about Mrs. A. Was there anything I could have done differently to change the outcome? I cannot help but think this way. When I am ready to drive again I go back to my apartment and have to talk about Mrs. A to my roommates and my family.
In trying to act like Mrs. A’s passing did not bother me, I actually was affected more. Mrs. A was the very first patient I ever saw pass away and in trying to act like it was no big deal, it made me feel even worse. In some cases, I should have allowed myself to experience my natural feeling of sadness and remorse upon the passing of Mrs. A. Although I did not know her well, the small amount of time I had spent with her left a mark on me. It is so important to take time to understand your feelings and let yourself be content with how you feel. This goes back to your life as a premed student because there will be times when you are obnoxiously busy trying to learn information and you may receive some bad news about a family member. Do not just continue on with studying and submerging in your work, take some time to evaluate yourself and give yourself time to be remorseful. The passing away of someone right in front of your eyes is a completely different experience that you cannot prepare for and the first time it happens to you, allow yourself to feel what you want to feel.