It was the first night shift of my ER rotation during my third year of medical school and everything was going pretty smoothly. I had examined some patients, helped put in a few IVs, and tried my hand at my first arterial blood gas. In the hallway I overheard one of the nurses mention that a cardiac arrest patient was en route to our hospital. The call originally came in as a patient who was short of breath, but as we would later learn, he crashed pretty quickly and needed CPR. I followed my attending into the room set aside for critical patients and found what seemed to be the entire ER staff in formation around where the patient’s bed would be in a few minutes. Within an instant, a gurney was being rolled in by the paramedics as they quickly filled us in on what they knew about the man and his medical history. Immediately, the nurses and techs descended upon the man and started trying to get IV access, with one person taking over chest compressions and another manning the bag valve mask. Watching intently, I felt lost, hoping to get involved but unsure of exactly what to do and where to do it. I was trained in Advanced Cardiovascular Life Support (ACLS), so I was very familiar with the treatment algorithms and medications used in these situations. My attending asked me to switch places with the nurse doing compressions and I excitedly stepped up onto the stool. I couldn’t believe that after multiple CPR classes, ACLS training, and many seasons of Scrubs, I was actually pushing on a dying man’s chest in a desperate attempt to keep his blood circulating around his lifeless body. His skin was cold, his lips blue and his eyes wide open. I was so focused on my technique I muted the conversations around me. The entire experience felt a bit surreal. Performing chest compressions correctly is extremely tiring, but I felt the adrenaline pushing me past my physical limits. After 2 rounds, I was relieved by someone else.
Because the patient’s specific heart rhythm was not shockable according to the ACLS guidelines, we mostly relied on compressions, making sure the patient was getting oxygen, and the administration of epinephrine, a medicine which improves outcomes in these types of cases. I remember imagining these situations in my mind many times and for some reason it felt different now than I expected it would. There was a sense of organized chaos without the desperation that you see on TV and in the movies. It seemed like everyone in the room knew what was inevitable but we were holding onto a glimmer of hope. At one point, one of the nurses alerted the team that he felt a faint pulse. Although we did not feel pulses anywhere else, the ER doctor retrieved an ultrasound machine to visualize the heart to see if it was demonstrating any organized motion. I remember looking up at the screen and realizing that we were all looking at images of a dying heart, sputtering out its last few disorganized beats. After 30 minutes of intense resuscitation efforts and a lack of any encouraging signs of life, the patient was pronounced. The doc and I took off our gloves and left the room. I was surprised by how little I felt at that moment. Why was I not emotionally moved by these events? Was my indifference a result of my medical education? I felt guilty for not feeling much. I wondered if the harsh nature of medical training has the potential to mold young students into doctors who no longer feel for their patients. A few hours into the shift when things slowed down, I got a chance to let my mind wander. I took solace in the fact that my numbed emotional state after the code was most likely due to my absolute focus on the medical side of the situation, rather than an unwillingness to empathize. I thought about the patient in a context much broader than the narrow, medical one my mind originally placed him in during our short time together. Even though I didn’t know him personally, I couldn’t help but think about how his death would affect many people close to him. I thought about those who would be grieving the next day. I thought about how he, like all of us, had his own unique struggles, victories and funny stories. As I drove home from the hospital that morning I thought about how he would never know the extent to which he forever changed a young medical student in a West Virginia emergency room.