How to save a life.

You can get use to anything. I've mentioned this before. Events that no normal person should ever be use to become absolutely routine for me. I've become jaded. It's an odd feeling to have when in so many regards the ER makes me feel human, alive and appreciative. And yet, I am completely and entirely jaded. It hit me with such force about a week ago. Made me upset about my complete lack of emotion, the fact I shrugged it off and was absolutely impartial. It's the whole separation of yourself from the situation.

Jaded: Tired, bored or lacking enthusiasm, typically after having had too much of something.  (The most perfect word for this situation)

I remember in high school I was in anatomy. We had to fully dissect a cat; skin, peel, identify, manipulate. "There's a thousand ways to skin a cat" my prof said. I disagree. You either do it right or not.

I panicked the first time I saw the cat. In a huge plastic bag, half full of formaldehyde, eyes slit open and tongue lolling out. They apparently get them from Mexico...I didn't ask questions after that... Not only did I just about have a panic attack looking at the bagged cat, but then had to go about the meticulous act of skinning. I found myself stroking the cats head as I did it. Maybe to comfort me, maybe to comfort the damn thing. But I got use to it. I had to convince myself it was fake. The cat was never real and was merely a tool for learning. Every day became easier. Cracking ribs, taking out organs, putting them all back in like a jigsaw puzzle. Get use to it or fail. 

How does this even remotely relate to the ER? That entire experience was pretty horrific, and I can remember just about every detail despite being 16 years old. The fact that on my practical I got "the functional unit of the kidney" wrong, and will ALWAYS remember that it's the nephron. Probably till the day I die. But it became routine. I've mentioned prior about people dying becoming routine. It bothers me to a point in that I don't like people dying and I don't like dead things (human, cat, etc). But the whole act of dying seems routine. I don't shutter anymore, I don't get a lump in my throat. It just is. 

We have new med students. Wonderful, smart, green, a little cocky. First time in an ER working. Everything is new and exciting and not text book. I love med students. They're like a science experiment. You get to watch them "grow" so to speak. My job is purely spectator and this is spectating at its finest. I like them because it tests my knowledge and allows me to play the "game" as I call it. The med students have a list of things they need to complete. One of which is CPR. Most of them don't get a chance to do CPR...it's not something like suturing or starting an IV which are a dime a dozen. Codes don't just waltz in. The med student my doc and I were working with was lucky enough to get code. An elder gentleman who went down at home. Was in asystole and despite the incredible work of EMS was still in that rhythm when he came in. 

Our med student stood coatless, gloved up and anxious. I remember my doc saying "don't worry, you can't do any worse to him. He's already dead. Remember if you crack ribs you're doing something right." Poor med student looked at me for reassurance, which I attempted to give through a smile and nod while she turned as gray as the guy who was wheeled in.

The beautiful chaos that is a code ensued. My doc intubated him, nurses pushed epi,  and med student went work. She was determined and from my 3 rounds of CPR training she did a damn good job. But he was old, and medicine doesn't stop the inevitable.  My doc ultrasounded his heart which quivered but wasn't compatible for life. And he passed. The formalities began. I went out of the room to do my work, my doc went to speak with the family but the med student disappeared. About 10 minutes later the med student surfaced. Her eyed welled up and nose red.

"That's the first time I've had someone die."

"Oh hun, I'm so sorry..."

"I don't get it."

"Get what?"

"He died."

"...."

"I did CPR, I did it right. He died. He didn't come back. I don't understand."

Tears start streaming down her face, and the breathing pattern became that of near hyperventilation. I get up and hug her.

"They normally don't come back."

"What?"

"If EMS doesn't get them back, it is incredibly slim that the team will here. I can't think of one patient I've seen come in as a full code still in arrest come back if they hadn't en route."

I felt upset watching her heart break, and her coming to a realization that this horrible situation was the norm. How do you explain to someone in her shoes who came in thinking she could save him, work on him, give it a 110% that this is normal. I have no medical school back ground. I haven't had 3 years of lectures and texts telling me X, Y, Z for success. People die. People die a lot actually. 

I steal her ice cream from pediatrics and sit down with her. 

"I was thinking about his family. His life, everything he's left now."

"You can't. You have to separate yourself. He's a patient. Know his name but keep him nameless. If you don't this will consume you."

She eats her ice cream and stares at me blotchy from crying. I'm still dry eyed, wearing a smile on my face and working on his chart. His past medical history, social history, time of death.

And it hits me. 

I'm jaded. 

And I hate it. I hate that I can separate myself, I hate that something like this is normal. I hate that she is over come by emotion and all I can think about is getting myself chipotle after work. I wish to be in tears with her or even feel some sort of emotion towards this man. But I don't. I feel hungry and sad for the med student's realization. And that's it. But that's the way it is. And that's how it has to be if the ER is your home, your niche, your comfort zone. It's disturbing but it's life in the ER.