“Mike passed away.” A momentary premonition from the previous sentence forewarned me, but the finality of that statement still crushed me. My heart sank. We had only called to offer another job. Our relationship was symbiotic; I had no time but had the money, you had no money but had the time. We bonded easily that first summer day, you needed a job and I needed help. You told me you were a vet, you did your time in the army, and when you discovered that I was a doctor, you explained how you almost died recently. A part of your heart had died, and then failed, and then stopped. You were resurrected in the ED, and then slowly revived in the ICU. Then you showed up on my doorstep a month later offering to pressure wash my house and clean out my gutters. You needed work. “Work?!” I exclaimed, “You need to take it easy!”
My thoughts drifted to that first resuscitation. I imagined the medical teams working rapidly but deliberately to save your life. One rhythmically “pistoned” your sternum, probably cracking a few ribs in the process. Another slid a large bore catheter into your arm and infused boluses of epinephrine and bicarbonate into your veins. Another slapped sticky electrodes on your chest and shocked your lifeless body. The team continued. A few minutes later your body resumed its vital functions and you were whisked off to the cath lab where the cardiologist snaked a thin catheter into the vessels of your heart to relieve the deadly blockage.
This time was different though, you succumbed to an overwhelming infection and had no chance, a complication from a previous intervention. I imagined your lifeless body lying in that ICU bed dying with lines and tubes protruding in all different directions. I cried. You didn’t live the easy life, your body told the tale. Your balding head was tanned and burnt, your arms were toned and sinewy and strong. You lived a hard life, a life of manual labor, but by design, you refused to be chained to a desk. You were aged physically, but young mentally, you were so full of life even in your 60s. The intensivist probably struggled getting that needle through your worn, leathery, weathered neck skin as he inserted that large central catheter. I smiled sadly. You were a hard dude, even in death.
Knowing you personally made your death so much more vivid, so much more alive, so much more devastating. You were not just another face in a sterile exam room, you were a person, alive, and fascinating. I regularly see death in my job, but recently it has become so clinical. Do I not care? Am I broken? Not human? Who is to blame? Was it the unpleasantly demented man today who said I was a liar, and that all I wanted was his money, and that I was stupid? Or maybe it was the obviously drug seeking patient before that, or maybe the one that was clearly abusing the system for personal gain. Or maybe the daily exposure to all of those unpleasant experiences had hardened me? Maybe I distanced myself subconsciously?
But then I remembered the inordinate amount of time that I spent in a 94 year old man’s room recently as he relived his World War II glory days as a fighter pilot flying the famed F4U Corsair – that beautiful gull-winged aircraft with a massive propeller that tore through the skies of the Pacific. He explained that being an engineer before the war simplified the physics and angles of anticipating and leading the enemy with his reticle during a dogfight. A naval officer from the greatest generation – one of the few still alive – was speaking history. I wanted to listen for hours, but couldn’t. So I moved on and apologized to the next patient for my tardiness.
Or maybe it’s the endless mandatory documentation that takes away from actual quality time with my patients? Or maybe it’s the perpetual grind of understaffing and overworking in most emergency departments? Or maybe it’s me? Maybe I’ve allowed myself to become callous? Maybe I’ve distanced myself to avoid the pain? Maybe it’s a protective mechanism when there is constant loss?
I just hope those caring for you in your final moments knew you, or allowed you to infiltrate their social barriers. I hope they held your weathered hand, softly touched your sunburnt shoulder, and comforted your failing heart in some way. I hope they were a little more human. I will miss you friend. I will miss our talks. I will miss our symbiotic relationship. You helped me, I hope I helped you.
I promise you this, tomorrow I will care. Tomorrow I will search for that unique life in each one of my patients that you so vividly showed to me. Goodbye my friend.