The Bird in Flight

58 year old Caucasian male, found in a parking lot at the side of his car... complained of difficulty breathing, some epigastic pain. has become unresponsive en route and tachycardic to the one forties... blood pressure is ninety over palpable... ETA to MTA is 5 minutes.

Understood, awaiting your arrival. Ten-four.

Status update... the patient is deteriorating, no longer has a pulse and we cannot get a BP reading... we are starting CPR. ETA 2 minutes.

The patient comes in on a stretcher, with one emergency medical technician (EMT) doing rescue breathing with a bag mask and another doing chest compressions - desperate measures to keep that vital oxygen flowing to his brain when his heart and lungs have all but given up. They rush the patient into bay 11, and our staff start to take over. We hear that he was on the way to the bank, and that he has metastatic colon cancer. The patient's head and shoulders are already visibly blue. My resident has all his intubation equipment ready, and he gives the order to stop CPR. He attempts to slip the tube into the patient's trachea. No good, restart CPR. I grab a bigger tongue blade and a better handle, and again he tries. The tube slips in gently, and we start feeding him air through the tube. We give ever more fluids. We give epinephrine. Atropine had already been given in the ambulance, so that's no option. We give more epinephrine. Still no good.

We are now 20-25 minutes from when he first crashed in the ambulance, and a quick ultrasound exam shows no cardiac activity whatsoever. The heart simply refuses to beat, despite the electrical rhythm displayed on the monitor. My attending decides that the effort is futile, and over.

Time of death, 10:31 am.

And that was it. The first time I've ever seen a man die in front of me. Sure, I've had patients of mine die (only twice though), but it was always something I heard about the next morning, or later after I've left rotation. It was a strange experience. I wasn't broken up nor did I want to break down or something. Why should I? I did not know this man, and although he was on the young side, his odds were certainly stacked against him. I had suspected he would die before he even arrived, I figured he had a 10% chance of seeing tomorrow. Still, there he was, blue and cold and still as can be, with a plastic tube coming out of his mouth. Still, life went on in the ER, people going back to work and joking around as they always did, seemingly unfazed. Who knows how many they've seen die. Heck, I'm sure some friends of mine are surprised it took me this long to see someone die.

I was fazed. My next patient clearly was not dying, and I started getting annoyed by his babbling on about his problems. When I realized this, I had to tell myself that he was no less needing or deserving of our help, just because he was not critically ill. I was there for him. That wasn't all though. I was just a little more jumpy the rest of the day. Every other patient looked sick to me, and I more often than not grabbed my resident to have him evaluate the patient first, just in case. Funny, I guess I do fear death, after all. Also funny, that feeling that my problems are trivial compared to that of the man I met in the ER today, the man who woke up today planning to wake up tomorrow and the day after. It's not true, of course; if anything, he's the one that has no problems now. Certainly up until now his life has been tougher than mine; a battle with metastatic cancer is no easy thing on one's life or psyche. And it's a terrible thing to die so tragically and unexpectedly. Still, I suspect it's a gut instinct to feel the way I felt, I guess part of what makes us human.

I dunno. I guess we do all have to go sometime. I just wish this guy could've not died today.