WARNING: LONG POST! Part of this story has been fictionalized to maintain the anonymity of the patients/families affected.
The day started with the usual: a sugar-free caramel breve with five shots of expresso as I begrudgingly walked from the in-hospital coffeeshop to PICU – where I had been assigned for the week – to make 6:45 rounds. The day ended with the usual: the local diner’s waitress vacuuming around me twenty minutes prior to midnight, while secretly hoping that I pack up my laptop and go home, so that she can close up shop a few minutes early. And in-between was a day unlike any I had ever experienced before; it was a purpose-defining day filled with incredible heartbreak, intense confusion, and truly extraordinary patient care.
I have the terrible habit of forgetting why I chose medicine. For fleeting moments, I forget that it’s all about the patient. And this morning was one of those moments. I put together my presentation on my patient – an eight-week-old female – and had my note 95% done, all before seeing her. I ran into my patient’s room, did a quick and dirty three-minute exam and rushed out when I saw her mom coming from down the hall, because I knew that she would want to talk for a while and rounds were starting in two minutes.
During rounds, I delivered my best presentation yet and gave myself a pat on the back. This was followed by my resident heaping praise on me, which, in turn, triggered my attending to do the same. All this praise for a student who got into this field because he had a passion for talking with people, but ducked out of his patient’s room to avoid that very thing. Rounds were long and painful today; they lasted until 1 pm. This gave me plenty of time to snag lunch prior to our back-to-back meetings that lasted from 2-4 pm. I decided to reward myself for such a “great presentation,” by leaving campus for a burger. O, how awesome am I?!
During these meetings – where I was barely paying attention – they discussed stopping ECMO on a patient that was not mine. I, uninvested, returned to trying to sneakily complete a few anki cards on my phone. We get up to do afternoon rounds at 4 pm and we start with this ECMO patient, an eight-month old male who just three weeks ago was completely healthy. He presented to the ED with grunting that was later revealed to be myocarditis, and by a twist of fate, he’s now on ECMO. His prognosis is dismal and his parents, newlyweds, have decided to stop ECMO.
When we arrive at this patient’s room, I immediately snap out of this disgusting, arrogant, fleeting moment of apathy when I realize that his parents are absent. They asked to be called before we stopped ECMO and alerted of the results after we stopped ECMO. Yes, they are aware that he’s not likely to survive this event. I immediately transition from arrogant apathy to judgmental rage. “How could they not be here for him?” “He’s all alone!” With no regard for what this poor couple has been through, I – a man fortunate enough to have a perfectly healthy daughter – turn up my nose as this couple.
My attending, however, is a phenomenal physician and has a compassionate, brilliant revelation. She does what we all should have; she put herself in this poor couple’s shoes. She explains to us that this couple should have to show up to see their son laying dead all alone. She, thinking out loud, articulates that someone should be holding him. I, without even thinking, volunteer. As I begin gowning up, all the judgment washes off of me. The only thing I feel as I walk into this room, is purpose. If this is the only thing that I was put on this Earth to do, then so be it. My mission, right now, is to be there for this baby and demonstrate to his parents, who cannot handle the gravity of the situation, that he was loved, even in his final moments.
So the pediatric CT surgeon gets to work removing ECMO. The pediatric intensivist – my attending – brilliantly manages his hemodynamics like a top-notch anesthesiologist. And for a moment, it appears that he may somehow survive without ECMO. But then the oxygen saturation begins to tank. The BP spikes, only to plummet. I wipe the tears from my face and grab him. I hold him like he is my own child. I rock him back and forth, I sing to him, I pray. The monitor flatlines. There is no long beep like in the movies, there is only silence. Thirty minutes pass before his parents arrive. I hand him to his mother, hug his father, and walk away.
Before leaving the hospital, I went back into my original patient’s room and waited two hours for her mom to return from her afternoon errands. I introduce myself to her, re-explain her daughter’s upcoming procedure to her, and ask her if she has any questions. I almost walk out the room after she says no, but something still didn’t feel right. I ask her if she needed anything and she jokingly responds with “a nap.” So prior to leaving the hospital for the day, I grabbed her a blanket and pillow. She smiles and thanks me for being a “good person.” I quickly correct her and explain to her that I wasn’t a good person this morning when I ducked out of the room. I apologize and leave the hospital.
On a day, where I forgot why I got into medicine, I found my purpose. I am heartbroken as I write this. I am heartbroken that this little boy died without his mother present. I am heartbroken that these two young newlyweds have to experience such hurt. I am heartbroken that I began this day with such arrogance, apathy, and judgment. I am simultaneously grateful. I am grateful that I was able to be there for this preicious little boy. I am grateful that I had an opportunity to apologize to my patient's mother. I am grateful that I was able to make someone's day just slightly more bearable. I share my experience with you because I hope it gives you a reminder that we got into this field to interact with and help people who are hurting. Do any of you have similar experiences where you truly got to experience the beauty and heartbreak of medicine, all wrapped-up in one patient encounter?
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