The change: A doctor reflects on how medical professionals cope with death on the job

Code blue, Seven South, code blue!"

I watched as the code team members made their way down the hall.

The room was empty now, except for the two of us. The room was so quiet and still, except for the muffled sound of friends and family outside the door. The antiseptic smell of cleaning solution enveloped the room. The blinds were closed, and the lights were dim, but a sliver of sunshine somehow had made its way in. The hurried sounds of nurses' and doctors' feet had been long forgotten. The incessant beeps of the pulse oximetry machine had faded away. Gone was the whooshing sound of the oxygen as the face mask clung to deliver hope. The IV pole was now a metal Christmas tree of plastic-bag ornaments with the mission of doing the now-impossible. The linens were crisp and white, leaving no sign of the struggle for life that had gone on just minutes earlier.

As I palpated the patient's neck for any sign of a pulse, I wondered whether she had known that today would be her last, whether she had had plans before coming to the hospital.

Had she cooked a meal the other day and put the leftovers away, thinking she would enjoy them another day? Had she taken a pass on a large piece of chocolate cake because she was trying to watch her weight, or had she snuck a piece later?

As I listened to her chest for signs of life, I wondered whether she had been a great singer. Or was she a great talker or listener? Whose secrets did she have hidden deep down inside?

As I checked her pupils for a response, I wondered whether she had seen all the things she had wanted to see. Had she put off a vacation or a family visit this year in hopes of trying again next year?

I wondered whether she had lived life to the fullest, or was she not ready to leave here yet?

Then I did as all of us have done, have had to do: I stopped thinking about her life, her hopes, her dreams, even her family, and did my job.

I checked her chart, reviewed the code notes. As I waited for the nurse to bring the death certificate, I reviewed my partner's notes so that I could have some knowledge of the "case" before I signed it. After filling in the blanks that would be this woman's legacy, I dictated my death summary.

Some family members still lingered outside the door, and I went to comfort them and answer any questions they might have.

Then I did what someone from the outside looking in-the patient's family, or anyone not in our profession-would not be able to do: I went home and tried to never think about this patient again. And when my husband kissed me and asked how my day was, I just answered, "Fine," with a smile.

SO NOT RIGHT?

Yes, this seems so not right, huh?

While sitting in one of my medical school lectures and hearing a similar scenario play out in a class about death and dying, I had thought to myself, "That would never be me. I am a caring and compassionate person. Even commercials make me cry. There is no way I could face death and go back to business as usual."

I still remember the first patient of mine who died during my residency, and I remember crying that night and not being able to sleep for days afterward.

I knew that that patient's death would not be the last one I would experience, and as the numbers began to add up, I began to feel the weight of the world bearing down on me. I believe that somewhere in there, "the change" happened. My mind and feelings slowly began to separate.

For me to function, to live, to work, I became two people. The first person still could cry during movies and commercials at the drop of a dime. That person had compassion for families and patients and all that they were going through.

The other person was different, a professional who got the job done and was able to control the compassionate one when needed. She could shut off emotion quickly and keep all feelings at bay for as long as needed, or wipe them out completely if they got in the way.

This second person we all have seen may seem cold and cruel to some, but as physicians, we are asked to do a difficult job that requires a savvy psyche. We work hours most people never will be required to work, we see and hear things most people never will have to experience in their lifetimes, and we still have to conquer the task of going home to be normal husbands, wives, mothers, sisters, and brothers.

Nevertheless, we have figured out a way to survive and live in the nonmedical world. And although we are and always will strive to be consummate professionals, we never, ever truly will forget those who have touched our lives in death and have made us the people we are today.

The author currently practices as a nocturnist/hospitalist at Hamilton Medical Center, Dalton, Georgia, and also does locum tenens work in Tennessee. Send your feedback to medec@advanstar.com
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