Living with death

Yesterday was an emotionally hard day at the hospital. A woman brought her 6-month old for the third day in a row, complaining of fever. When the infant was seen on Thursday, the attending doctor gave the child some ibuprofen and tylenol to control the fever and sent him on his way. On Friday, when the baby returned after having a febrile seizure, the mother was again instructed to control the fever with adequate tylenol and motrin, some blood work was drawn, urine was tested, and the baby was sent home. Yesterday the infant returned, still with a fever. The baby had a whimpering cry, but we see this sort of thing all the time. The patient appeared to be stable and was sent back to a room where more blood and urine were collected. Because the infant had been to the hospital three consecutive days, the MD decided to perform a lumbar puncture to test the infant for meningitis. This is a procedure that most doctors try to avoid because it can be very stressful for the infant. When the doc put the needle in the baby's spine, the baby began to take agonal breaths and proceeded to stop breathing. The nurse at the bedside began CPR and they wheeled the baby into the code room. I have never seen a doctor look so panicked as this usually-calm MD struggled to intubate the child. Multiple pages were made over the loud speaker to get an anesisiologist to come to the emergency department for assistance. This is unusual in itself because the emergency room staff are usually the first responders, the ones who help other floors when there is a code. There were tons of people in and out of the room, trying to save the baby. Finally, they were able to get the child stable enough to transfer him to a pediatric ICU. We found out 30 minutes after the transfer that the baby had died.

What went wrong? Maybe nothing. This experience chilled me to the bone. How many times do we send people home that may have life-threatening illnesses? I have seen this twice now. It is scary. Of course we save more lives than not, but our humanity is so precious.

I realized yesterday how crucial teamwork is in the emergency department. The doctors and nurses were side-by-side providing physical (and sometimes emotional) support. My job may seem draining, but the work I do really is important. Not many people can say that. I sometimes wonder why I put myself through the emotional turmoil of life and death, dealing with people of all ages, social classes, and religions... I feel all of these things so deeply, and it is painful. I don't want to become numb, but it is hard to process and work through difficult life experiences. I am often scared when taking care of patients, and I think that is ok. There should be a little fear in the face of possible death. I do not want to let this inhibit my learning and ability to care for those that may be dying. I want to challenge death with strength and accept it with grace.

I am comforted by the words of Elizabeth Kubler-Ross:

"Both birth and death involve great changes and adjustment, often inconveniences and pain, but also joy, reunion, and a new beginning. If it were not for our inner knowledge that we are on this earth plane for a relatively short time, then why should we strive for perfection, for love and peace, if it were not for the desire to leave this place a little bit better, a little bit more human than when we entered it?

We make progress in our society only if we stop cursing and complaining about its shortcomings and have the courage to do something about them. It is painful to admit our own fears, sense of guilt and shame, inadequacy, and low self-esteem; however, it is the brave one who admits these, the strong one who will fight his own negativity, and the trusting and faithful one who will see the light at the end of the tunnel."
-Elisabeth Kubler-Ross