Year in Medical School:
Where you grew up:
Wake Forest University
"What we hope ever to do with ease, we must learn first to do with diligence." - Samuel Johnson
ACLS protocols were being followed by the doctors who surrounded the crib in the NICU. What did that mean? In the case of the patient in question, a 610 g, 24-week-old baby girl, it meant that one finger was used to perform chest compressions while miniscule doses of epinephrine were pumped into her veins. Emma was her name, and the doctors who surrounded her crib were surgeons who were struggling to place a central line in her internal jugular vein. The intervention failed, as did the attempt to resuscitate her.
In surgery, I have been gratified to see patients whose sight has been restored, parents whose children, once sick, can now walk and eat and grow. These are the happily ever after stories of surgery. Patients become well, sometimes quickly, sometimes more slowly, but then they leave the hospital and, good health restored, carry on with their lives.
When Dr. Block saw that Emma* was rapidly deteriorating, he rushed to speak with her parents, who decided, ultimately, to stop trying to revive her and to let her die. The look on her mother's face as she was wheeled into the NICU by her husband was heartbreaking. Still weak and weary from having given birth two days before, her whole body seemed to have folded in upon itself, compressed by the invisible weight of grief.
Emma was the first patient I have ever seen die. And only the second person. On Christmas Day of this year, my grandfather died. At 94, he had lived a very full life. A quick illness spirited him away, and before his death, he spoke of being ready to rejoin God. So as his rate of breathing slowed and I watched his body slip away, I felt a sense of peacefulness mixed with my sadness.
But when Emma died, I felt deeply the profound difference between a child's death and the death of an older person. Grandparents die and we are left with memories of their lavender scents, pictures of beach vacations, recipes for banana bread. But when children die, their parents and those who love them are stripped of the future - dreams Emma's mother may have had for her were, like the Langston Hughes poem, always going to be deferred.
What happens to those dreams a parent carries in his or her heart when a child dies? How do parents go on with their lives after experiencing such loss? These are the questions I began to think about after I saw Emma die. As physicians and physicians in training, in our case, it often feels like we live in the hospital. The world within these walls is familiar and mundane, and it becomes hard to imagine what life lived entirely outside it was like, could be like. But for our patients, life is exclusively outside the hospital, and the death they encounter here reverberates outward.
That fact is important as we reflect upon how we're treating people, not "patients," not numbers and lab values and vital signs. Kind and empathic counseling for patients and their families at the bedside and in the office can help ease the sadness people feel upon hearing a diagnosis or witnessing the last moments of a child or a parent. It's a struggle for me to know that's all we can offer - once our patients are gone from the North Carolina Baptist Hospital, they're outside our domain. Their challenges - moving forward with illness or disability or recovering from loss - are solely theirs to bear.
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