Time of Death

A few weeks ago, I experienced my first death in the operating room. I was on call for 24hours on this particular Saturday, already 18 hours into a crazy busy day and I received a call from the emergency department. There was a patient with a ruptured Abdominal Aortic Aneurysm (AAA) who was brought into the ED hypotensive and unresponsive. The necessary OR staff was called in from home and since I was already at the hospital, I hurried to set up an operating room, eat my first meal since noon and run a potential plan of action through my already frazzled brain. When I arrived in the ED to assess the situation, I quickly realized the gravity of it. The patient was already intubated, his blood pressure was 49/25 and he had 4 peripheral IVs in place with blood running through them all. The vascular surgeon had just arrived by that time and after we quickly discussed a plan, I high-tailed it back to the OR in anticipation of the action that was about to begin.

In order to keep this post HIPPA compliant and to not rehash too many details in my mind, I’ll briefly summarize the events of the evening. Once the patient arrived in the OR, I began placing all of my lines and getting the fluids, blood and pressors in as the surgeon worked quickly to place an endovascular balloon in the aorta to stop the bleeding. He and the surgical technician worked swiftly but seamlessly together to repair the rupture as best they could while my anesthesia tech and I did all that we could to replace the lost blood and maintain a reasonable blood pressure. All throughout, we remained optimistic that our efforts would not be in vain but after 3 hours (and who knows how long prior to coming to the hospital), our patients heart couldn’t take much more and he died.

This, unfortunately, is not my first time experiencing death. After nearly 5 years in independent practice and 4 years of residency training, death and dying has become an unfortunate reality of our lives as healthcare providers. This was not even my first ruptured AAA surprisingly and I would certainly like to put it out into the universe that I feel my quota has been met. But something was different about this case. After such a long call, starting this type of case at 1am was mentally intimidating and physically taxing but my instinct to “just get it done” kicked in. As most Mavens in healthcare know, the “I’ll do it tomorrow” or “I’m on my break so I’ll do it later” doesn’t really apply in our line of work, so we quickly learn to “just get it done”. This is the same creed that our Maven moms and wives also live by, because our families, like our patients, depend on us. So on that night, tired, hungry and mentally exhausted, I decided that this patient’s life took priority over all of my needs and I would do everything to make sure he returned to his wife for Sunday dinner one day soon.

The harsh reality is that no matter how hard I train, how prepared I am for an emergency situations or how mentally tough I think I am, there will always be a problem I can not fix, a situation I have not prepared for and a life that I can not save. It is in these moments that I have to be most grounded in my faith, trusting that there is not only a plan but a purpose for all of the trials in my life no matter how difficult it may be for me to understand. It is in these moments that I understand the importance of the women I have met along this journey in medicine, my fellow Mavens, who I can reach out to for support and understanding. It is in these moments that the love for my family is solidified, realizing that despite their minimal understanding of exactly what I do on a day-to-day basis, their belief in me and certainty that I have the nothing but good intentions in my heart, is unconditional.

So the following day after a major slumber, I went to brunch with my boyfriend and let it all out. The tears that began flowing earlier that morning on my drive home, continued as he reassured me of my strength and good intention. I explained to him that I was conflicted even in my grief because my tears were partly because of the life lost and the thought of the grief that his family would go through, but also because of my presumed failure to save that life. I was frustrated that the culture of healthcare in the United States is to fix everything at all costs, sometimes turning a blind eye to the families that have to deal with the consequences of these decisions.

After a weekend of rest and reflection, I concluded that I am still grateful for the opportunity to be a part of a team and a profession that can help to save a life. I am grateful for the people and institutions in place to help me cope with the reality of death and dying. And most importantly, I am grateful for the tears and thoughts that follow these tough moments because it reminds me that although some may think we attempt to “play God” in the field of medicine, I am still only human. To quote our recent Maven in the Spotlight, Amanda, “the day you stop crying when bad things happen to good people…you should retire.”

 

How do you handle the reality of death and dying in our profession?

 

-STS