I struggled with conveying to you how untrue that was; how I worried about you when I was at home, how I checked every morning to make sure you hadn't gone to the ICU overnight, how I tried to exhaust every option for your care. My explanation didn't mean much to you - after all, half the days you refused to talk to me or let me examine you. I know it was your mental health diagnosis and the frustration of your prolonged hospitalization but it stung to hear that.
One day, your name wasn't on the board and my fears were confirmed. When you came back to the ward days later, things were even worse. Despite the onslaught of antibiotics, pouring blood products into you, and so many interventions - things were getting worse and the end was approaching. The hematologist told me that we simply could not continue like this.
I heard the unmistakeable announcement overhead and prayed that it was not your room number - my stomach dropped when it was. I don't know how I made it through my training without witnessing a code blue on one of my own patients but somehow I had. And this time, stakes were higher - I had been following you for weeks and was thoroughly invested in your care. As I was fresh out of school I still harboured hope and naivety that death was a failure of medical intervention. Despite your perception I didn't care about you, I was still trying to do everything possible to turn things around.
Adrenaline surged as the frenetic activity of a code exploded at your bedside. I felt myself panicking, unable to remember anything from ACLS, but most of all I remember feeling useless. I felt so ashamed of myself, especially after the anesthetist asked me to put the brakes on the bed and I couldn't even do that. I can vividly remember how the nurses' compressions jarred your poor, cachectic body and my instinct was to tell everyone to stop, to leave you alone, to let you die in peace.
I called your brother back - it had been scarcely two hours before that I had spoken with him to arrange a family meeting, but a code blue doesn't pay attention to schedules. "Your brother went into cardiac arrest and it doesn't look good. Do you want us to continue?" Your brother was taken aback; told me to "do everything" and that he was on his way. I told the code team of his family's wishes and then I left the room.
I felt like a coward for running away. I felt useless and stupid and somehow, in an utter twist of logic, that I was responsible for the outcome. I cried in the back room. Not an attractive, elegant way of crying but intense, body-wracking sobs where it felt like I was shattering inside. I felt like an incompetent failure.
You were whisked to the ICU after miraculously getting a pulse (artificial as it was). We knew, though, that there was no coming back from this. I learned about the compassion and resilience of my colleagues when my embarrassment about breaking down was met with support and validation. I learned that my softness is strength rather than weakness and it's better that than being numb.
I met your parents the next day. It broke my heart to see the frail, elderly couple in matching wheelchairs clutching each other and sobbing about the imminent loss of their son. It seems so unnatural for a parent to outlive their child and there is no comparable grief. Your brother told me how life support was going to be withdrawn in a few hours. You died very shortly after.
They say "you never forget your first". Your death has stuck with me. I dreamt about you for a few weeks. I broke down crying during a class at the gym a few days later. Vivid images of the traumatic code and clips of your parents crying popped into my mind unbidden. I ran through the clinical scenario a myriad of times in my head to see if there was anything I missed; anything I could have done that would have changed the outcome. But there wasn't. Your life was never in my hands. We did as much as we could for you, and you helped me learn a hard lesson that despite our efforts, people die. Regardless of the advancements in medicine, we are not in charge of the outcomes. From Him we come and to Him we return.
"There should be more [health care professionals] like you." When your brother said that to me, I didn't take it as an ego boost but rather as a reminder of why I do this. I will never forget you, Mr. A. I hope that before the end, at some level you realized that you were (and never will be) just a number to me. Thank you for the lessons and the influence and perspective I gained from you.
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