A four year old boy drowned. In a pool, in the middle of winter. He had been dead, was resuscitated by the paramedics, and was brought to meet me and the attending pediatrician in the ER. As I put the bagged oxygen mask over his mouth, I wondered if he had been eating a blue popsicle before drowning? No, I realized, his tongue was that color because he was so cold. Reaching out to touch his baby hand was like holding a refrigerated chicken wing. His eyes were brown, dull and unseeing, under his closed eyelids. His temperature was 85 degrees, and his lungs were filled with water. Listening to them was like ascultating an aquarium. He wasn't getting enough oxygen, even with the bagged oxygen mask, so we needed to intubate him. The ER doc tried first, pushing the tube down his throat. As the ventilator was turned on, his stomach distended with air. His heart rate dropped down into the 30s, and bagging was resumed. However, the bagged oxygen mask was now cracked, and he was losing oxygen and his heart rate was falling. The doctor gave the laryngoscope to me to try, and I opened his mouth, visualized two tiny vocal cords, and pushed the tube in. Pool water sprayed out, soaking my shirt and face, and the monitor alarms went off. In the few moments it had taken me to intubate, he had gone into asystole.
Asystole. Pulse zero. Respirations zero. These are all medical terms to describe death. The death of a kid that had been a normal little boy a few hours ago, and was now cold and lifeless under my shaking hands. The doctor shouted, "He's going to die!" and my stupid brain wondered "Isn't he already dead?"
The attending and I talked with his parents, explaining what had happened, and invited them to come see their son. As I watched mom kiss around the intubation tube, and dad touch his son's cold, dusky feet, my heart broke for these parents that turned away from their child for a minute and will now live with a lifetime of guilt. A couple of tears slid down my face as I watched these parents desperately try to reach their son, and grapple with the realization that he was not there.
My lungs were clear, but my heart was drowning. How long would it be before I forgot the sweet detail of this child's face? How could I not wonder if I could have done something better? When would I see other children as they are, rather than thinking about how they would look drowned like this little one? After all, he was a healthy boy a few hours ago, with a chest that heaved with exuberant play instead of the force of a ventilator. Why was I the only one that seemed to be bereaved by the loss of this child?
My friend June, who has been a wonderful nurse for longer than I've been alive, offered some perspective. Some doctors build protective clamshells around themselves, shielding them from experiencing patient pain. Sometimes this dissociation is necessary in order to care for someone in great distress. But to be too far removed is a disservice to patients and their families; patients need doctors who are there for them in the most difficult of times. She also reminded me to be gentle with myself. All of the distress and grief I experienced over the loss of this child are some of my best attributes; they indicate a caring and empathetic nature that ultimately will benefit my patients. It also indicates that my self-awareness is set correctly, because questioning and analyzing situations like this is the way to maintain a humble and teachable spirit. However, that does not mean that these situations are easy on me.
This is not an easy job. I never want to wear those chlorine-soaked scrubs again. Suddenly I don't like my stethescope, because it allows the amplification of human suffering into my ears. I don't know how to move on and forget about this kid that was the most awful situation I've ever seen.
All of these events form a collage of who I will be as a physician. With experience, I'll learn how to reach an equilibrium where the pain and triumphs of my profession are balanced with the rest of my life. And I'll know that while this experience will stay with me the rest of my life, there is a new patient outside my door that deserves every bit of the best care that I tried to give this little boy. It's not right for grief to cloud my focus on the next patient, because there is always more need to be met.
People say medical school is hard. What they don't say is that the academics are extensive, but attainable. What you really wrestle with is the ability to develop meaningful doctor-patient relationships. To emotionally engage with someone that is in pain is burdensome, but a privilege. Doctors have the unique opportunity to be part of peoples' lives in exquisitely intimate moments. I think most people would say that they go to medical school to "help people." This is probably partially true, but I think it goes beyond this. I think the desire to become a doctor stems from a deep yearning to offer people a part of us; the ability to treat illness but also relate to them in a time of difficulty, to meet needs that are seen and unseen. And I think if you do it right, you come away with more than you ever gave.