We have become so used to the dying that rarely do we take time to acknowledge, on a deeper level, what is taking place. That is mostly for our own protection. Our hearts are resilient and fragile, just like yours. Once you cross that line from life to death and enter our realm, the ER, you are dangling between two worlds. All our trained senses kick in and it is our job to pull you back from the light. You aren’t human anymore. You are our mission.
Except, we have done this countless times, with almost always the same outcome. We have been taught to keep you here, despite the terrible existence we know most likely awaits you if we are successful. We don’t stop or give up until your distraught family member finally says “enough”. That rarely happens, because hope, guilt, fear, denial and love are all present. Rarely does the love of sacrifice overcome. I’ve been doing this now for 20 years. This is the second time I can remember crying in a code. Your wife showed me, showed us all, selfless love.
At the age of 83, I imagined you had lived a good life. When our emergency radios went off and EMS let us know that they were bringing you in – a cardiac arrest, with no pulse for over 20 minutes – I didn’t jump up. You still wouldn’t be here for another 15 minutes. That’s plenty of time to eat my ulu burger, take a piss, wash my hands, and then saunter over to the resuscitation bay. I really don’t want you to live, but I l know this drill. Your brain is already dead. But give a heart enough epinephrine and it will start beating again. Which only leads to delusional hope for the family and some bullshit sense of accomplishment for us that we can revive a corpse.
I’m not so jaded as to give up on miracles. They do happen on a rare occasion. But they happen despite my best efforts, because that is always what you will get, even when we understand the horrible truth. We can’t help ourselves. It is ingrained into our beings from those that came before us. Death is a failure. Life is the winner, no matter what the cost. Even if you will never open your eyes again, smile, or kiss her on the lips, you will have a heartbeat, but no functional brain. Our job here is done. And then we will move on to the kid puking in Room Five. That is our life in the ER.
She would have none of our nonsense today. I saw her out of the corner of my eye, in the hallway, as I looked at your heart with my ultrasound. It still moved, but not enough to sustain a meaningful life. They bought you some time so I could talk to her. I did not expect her to be reasonable, or even rational. Who could when her husband was lying there in suspended animation?
“Are you the attending physician?” she questioned as I approached, with a confidence in her voice that I did not recognize, given the circumstances. She wanted it straight and that is exactly what I offered her. My decades of experience as an ER doctor, who had attempted to resuscitate countless bodies like yours, told me that you most likely would not survive. And if by some chance or “miracle” you did live, you would not be the man she knew.
You surely would never swim in our Hawaiian waters like you did today. It was all you had talked about since your arrival two days ago. Stepping in to that famous snorkeling spot adjacent to the sacred refuge, with the twelve-year-old boy who had become a family friend each year you visited our enchanted island, was your welcome to paradise. Peering through your mask for ten minutes at the alternate, surreal universe you saw below must have started your journey into the depths of the unknown that most of us fight frantically against, as if we were drowning.
But you did not drown, and I do not think you fought. You simply floated back to shore, pulled yourself out, collapsed, and then died. In this remote location, you had a doctor at your side immediately performing CPR and a defibrillator that shocked you three times. You had all the makings for a possible “save.” It could have been a scenario fit for television.
Yet, here you were before me, soon to be a bedridden vegetable and most likely unable to control your bodily functions, if I continued down my trained path. There would not be some fairy tale outcome that you expect from the movies, unless you were watching a zombie apocalypse flick. Don’t worry — I wasn’t that abrupt with her.
She took in my slow, gentle, but honest words, methodically calculating her next question. But I interrupted with my own — sorry, the monitor told me you were about to die again. I wanted to know if you had an advance directive, and what your wishes were if this situation should ever arise.
“He would never want to be resuscitated or on machines if there was no chance.”
Before I could go any further, we lost your pulse again and I attempted to excuse myself, to lead the team in yet another futile attempt to restart your heart.
“I want to be in there. I need to be in there. And I need to be on his left side. It’s the only ear he can hear out of.”
Bringing in the family as we perform CPR has always been a good idea to me. It typically helps them see how hard we really are trying, but also how very brutal it is on the body. She didn’t even seem to notice the myriad of people taking turns pushing vigorously on your chest as sweat poured from their bodies, slamming the drugs into your veins like a huge tsunami wave, or bagging the tube that was breathing for you with highly concentrated oxygen. She only saw you. She only spoke to you. She only yelled her selfless words into your one good ear to make sure you really heard and believed her.
“Go to the light. You can go. Go now. I know it’s magical, like the ocean. Don’t be afraid for me. You don’t have to worry about me. I will be fine without you. I will make it without you here, as much as I don’t want to, but this is not about me. This is about you. You were so good to me. You were such a good husband, such a good friend. You are loved. You showed me how to be strong. I release you. If it is your time, don’t hold back. Your work here is done. Go to the light, my love. All these people are working on you so hard to keep you here. I know you have done it for others too. But if this is your time, I need you to go now. Float away to that beautiful paradise.”
As the leader of this orchestra, I looked around at each nurse and tech, fighting frantically against their tears as you played the final notes on your monitor. We all wanted so badly to drown ourselves in that kind of selfless love. To love and be loved so fiercely, it was rare. We were so jaded. But even the toughest of us fractured that day. Your wife split our hearts wide open. And then yours stopped for the last time.
Image credit: Pixabay
