On death and dying

My experience in general surgery and trauma calls at night immersed me in a world with really sick people, some of which ended up dying. My first experience with death was overnight on trauma call. A man came in as a "cat 2 MVC + EtOH" meaning he was like most of our trauma patients at an inner city hospital- drunk, driving, and badly hurt. After securing his ABCs (airway, breathing, circulation), we saw his only obvious injury was a broken arm. He started becoming more agitated and it took almost 6 of us to hold him down so that we could finish our exam for injuries. A few moments later, we realized that he had no pulse and that his heart was no longer beating. I started chest compressions on him for what seemed like forever (in actuality about 3 minutes). As I was beating on his chest I couldn't help thinking that I was keeping him alive at that moment. I didn't expect the chest compressions to work- I had heard of the statistics that less than 10% of patients who receive CPR make it out of the hospital alive- but somehow miraculously he re-gained a pulse. He was brought back to life. We re-evaluated his injuries and discovered that he had an acute abdominal bleed. His blood pressures started dropping and we realized that he would need to go to surgery immediately to try and stop the bleeding. I helped transport him into the operating room. He lost his pulse again. We started chest compressions again but realized that stopping the bleeding, and not keeping his heart pumping was his best chance at life. Without much time for the usual sterile techniques and precautions, we essentially sliced into his abdomen and 3 L of blood gushed out of his abdomen, soaking us all. We quickly surveyed his injuries and realized that they were too severe to correct, he still had no pulse, and there was nothing we could do for him. He was pronounced dead a little after 20 minutes when I first met him. I helped sew up his abdominal incision and couldn't help myself from thinking that just 20 minutes ago, I was talking to this man, hating him for being so agitated so drunk so careless. Now, he was becoming cold and stiff as I finished up his sutures. Now, I realized that I had seen life leave a person's body for the first time.

After watching so many episodes of ER and other medical TV shows that dramatize what I did for the past 4 weeks, I can now appreciate why so few physicians watch them. The truth is, after crying after watching a patient die on TV, I had no emotional response to seeing my first patient die. I felt numb. I wanted to feel something. Instead, I went on to work up the next trauma that night and went on to the regular OR cases later that morning. I always thought that death and dying would really affect me and my ability to practice certain types of medicine. Instead, almost instinctively, I became numb to it all. Almost instinctively, I adapted the same coping mechanisms for dealing with death (dark humor, sarcasm, indifference) that I had promised I would never have. And despite the fact that I wish I could feel differently about my first patient's death, I realize that if I had let it get to me, I would have had a difficult time continuing to work and finishing this rotation. I'm not really proud of who I became over these past few weeks but I felt that I had to in order to get through all experiences that were thrown at me.

In the end, I witnessed 4 patients die on trauma call and I was responsible for withdrawing life support for one of them. It never become easier to witness death but I did stop searching for an emotional response. I hope that a few days from now, once I've caught up on my sleep, I can reflect on these patients and their deaths... and maybe even have a good cry to prove that I'm not numb after all.