Wednesday, November 16, 2011

The Achilles Heel

My cousin said something to me not too long ago that really resonated with me:

"Your normal, even good day in the ER is somebody else's worst."

It's weird to think about, that my typical work day where I'm laughing, happy and going about my normal routine is a patient's last day or most traumatic day in their life.  It's sobering to think of it that way. I was trying to explain what it was like working in an Emergency Room today, especially a level 1 trauma.  I explained that you have to be desensitized to it all and allow it to be a normalcy to be able to continue working there.  If everything became personal you wouldn't be able to emotionally survive.  It's a coping mechanism.  You either adapt, or get consumed.

This doesn't come immediately, which I think is evident when I talked about the first time I saw someone die.  I'd say the first month I was in the ER I was at a constant state of on edge and emotional overflow. But the more times you see something the more routine it gets.

You can honestly get used to anything.

Sometimes that scares me.

Every once in awhile though you'll get that patient or that family that hits your achilles heel and you're human again. The funny thing is, it's not the most graphic event or even the most traumatic.  It's something that all of sudden ties you to that person and makes their tragedy yours too.

There is one that sticks out for me that happened maybe 5 months ago. I was working a Friday night and it was around dinner time. I was working with one of my favorite docs and was in a disgustingly good mood, which I normally am at work. We had an ambulance come in, on our board it said "SOB" or shortness of breath.  I watched them wheel her in, and remembering how it was eerily somber.  The patient was around my mom's age who had end stage breast cancer that had metastasized to her lungs.  She was still living at home with her family and just having comfort measures instead of treatment anymore.  She was also a DNR. We walked into the room and on the gurney she was laying motionless, eyes open and lifeless. That was the first thing I noticed. Her eyes were dull and partially open. When people say "All the life in their eyes were gone" it's true.  I don't know how to better explain it than that, the person is no longer there.

We were caught up to speed by EMS, she was at home with her family and got short of breath. Family called EMS and she passed away en route. All of this was fine, I was emotionally unconnected. It was tragic, sad, as it always is when someone dies, but not something I would particularly remember otherwise a month from them.

Until her daughter came in.

Her daughter was close to my age.  She had come with her sibling and father thinking that her Mom was just short of breath, was going to the ER because she had a hard time breathing. Never imagining that she wouldn't see her mom alive again. I was still in the room when she came in, walking into the same scene as me; lifeless pale body, eyes partially open and dull, dead still.


It felt as if all of the air had been sucked out of the room. She walked to the gurney, put one hand on her leg while a paramedic said he was so sorry that she didn't make it.  She looked at our faces in disbelief and lost it.

"No...No...Mommy, no, she's not dead. Don't leave me. Mommy?"

Then it hit me.

All I could think of was my own mom and how at 22 I couldn't imagine a life without her. I couldn't imagine her being alive one minute and dead the next. I couldn't imagine going through this stage of growing up not having her by my side. I couldn't imagine her not at my graduation, watching me walk down the aisle some day, or her holding my first child. It was such a terrible feeling I still can't even fathom it. All I could see was someone my age in shoes I hope to never fill.

Suddenly it became personal.  Her loss was now mine now too.  The pain she was feeling washed over me, and I had to walk out before I completely lost my composure. Even now writing this it brings me to tears, it became real. I would have done anything to bring her mom back.

It's crazy how in a split second how something can go from being routine to knocking you flat on your ass.

I'm grateful for it.

The rest of my night had a heaviness to it.  I was no longer laughing or smiling, just doing my job so I could go home. The minute I got into my car I sobbed.  Sobbed because I was so heartbroken for that girl.  I sobbed because I was thankful that my mom was at home, that my family was healthy. When I got home I gave my mom the biggest hug and reminded her for probably the 5th time that day that I loved her.

I love the ER. It keeps you grounded. It humbles you and makes you human in a way that no other profession or experience can.  It reminds me constantly just how lucky and blessed that I am.

DNR (Do not resuscitate)- A person who is a DNR has legally stated that they do not want CPR, mechanical breathing or outstanding measures done if their heart stops or if they stop breathing. 

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