Walking into the ER, I was completely annoyed. Mostly I was pissed with myself that I had been bamboozled into doing this damn night shift on a holiday made for drinking. This was the funk of getting sideswiped by my hoodwinking boss and I couldn’t shake my disgust. So instead of being my perky positive self that night, I became a Karen. Every patient annoyed me. Their ailments were bullshit as far as I was concerned. Whiny, ungrateful, drug-seeking bastards were all I saw. It was St. Patrick’s Day, for god’s sake. I was supposed to be out drinking green beer, even though I disliked beer.
I had tried to lighten my mood by dressing all in green. I looked ridiculous and I didn’t care. I wore a green headband with green sprouts of hair. I looked like an alien, to be honest. One patient looked at me in surprise and asked, “Who the hell are you?” I did manage to laugh and reply, “Your doctor of course! How the hell are you?”
The scribe who followed me everywhere and typed up my charts was new. Poor damn thing. He had never met me before but I had a reputation amongst these young aspiring doctors, nurses, and physician assistants. I was one of the best. Not only because I was a blast to work with, but also because I cared. I was funny, laid back, honest, silly verging on ridiculous, and completely inappropriate in half the shit that came out of my mouth. In short, I was one of their favorite doctors. Scribes switched schedules just to work with me. He was surely taken aback by the bitch that showed up that night, even if she was dressed all in wacky green. She was really no fun.
And then everything changed.
I happened to be sitting at my desk when out of the corner of my eye, I caught the image of one of my favorite ER nurses who had moved into working in the ICU. None of those guys usually ventured back into our chaotic world in the ER. He rushed right up. “Have you seen your Code ICE lately?” “No,” I replied, “not since the day after he was brought back from the dead. He looked like shit.”
“You have to go see him. Go see him now before he leaves the ICU.” Something in his voice made me follow his command promptly. I found myself jumping out of my chair and heading straight to the ICU. Grabbing my scribe, I told the other doctor to cover the place. I had no control over my body. I just went with it as if I had pricked my finger on a magic spindle.
Could this man really be alive? I don’t mean just present in a physical body but really full of aliveness – not just breathing and taking up space? Could he function? Could he talk? Did his eyes work? Could he recognize his wife, his kids, or even himself? Could he shit and piss on his own? I was very doubtful even though I believed in miracles probably more than most.
My Code ICE had just turned 52 years old the day after he died. I had been working the day shift a few days prior. We got a frantic EMS call of a cardiac arrest that they were working in the field. It didn’t sound good from the broken fragments of information that we obtained over our radio. He had been down or dead for at least 45 minutes but they had a pulse back after a prolonged period of CPR, a few shocks, and lots of drugs.
As EMS rolled in this large, lifeless black shell of a man, I was able to get a little more history. He had been at work and was eating lunch when he collapsed right in front of co-workers. They were immediate in starting CPR on the scene and even had an AED (automatic external device) that they used to shock him before any professionals showed up. They had actually performed perfectly, like the textbook CPR cases. They did everything right. And he was still dead when paramedics arrived.
All efforts were thrown at this corpse to bring him back. I knew these medics and they were fabulous. They didn’t give up and they always kept their cool even under the worst pressure of imminent death. They were the kind of people I would want taking care of my family or even my own self. But regardless of how good we may be, I have come to believe that our death, just like our birth, is really never in our hands. We can execute our medical knowledge perfectly and still have no return of life. It happens often and is something I have learned to accept with great gratitude and sadness.
Today was clearly not this man’s time to die. Right before the ambulance reached our ER, all the efforts of his co-workers and the EMS crew worked. There was a pulse. He had a return of spontaneous circulation. The only problem was that this man had now been dead for 45 minutes. His chances of any meaningful survival were dismal. His heart may be working now but would his brain?
I didn’t have much time to think. I just reacted. All my training kicked in and I went to work on my part of this chain reaction. First, I needed to obtain a definitive airway. I needed to put a tube into his windpipe so that we could deliver oxygen to his organs through a ventilator since his brain was not prompting him to breathe. This was not a good sign either. Nor were the fixed, dilated pupils I saw when I shined a light into his eyes.
I removed the temporary tube that EMS had placed. His lunch that he was in the process of eating when he died landed all over my right arm as I pulled out the spout that had been keeping him alive. “Ham sandwich with mustard!” I yelled. Once his airway was secured and we had him connected to a breathing machine I called “the Code ICE.” This was an overhead page in the hospital to mobilize a specialized medical team to induce hypothermia.
Basically, we would lower his body temperature with a special device, hoping that this would stop more damage and allow his brain to recover. It was really the coolest thing I had witnessed in my career as a doctor. I had brought back so many corpses only to watch them become decaying vegetables. This was really a therapy that had proven to benefit the living dead. I had read all the research and had even helped a few dead folks with this technique but never had I seen one person walk away from a cardiac arrest with such a prolonged downtime.
I didn’t have much hope for this guy either, but I worked on him just the same. We initiated the cooling and then my favorite Intensivist took over. He was so intelligent, polite, and such a dork that it made him attractive. I dare say he was close to a genius. I thought to myself, “This patient had the best care possible. Whatever else happens is in God’s hands.” And then I instantly knew that really all of this was in God’s hands; every tiny perfect detail.
I felt very confident walking into the “quiet room” to let his wife know just what I had witnessed. This man had been given every chance to live. Yet there was a part of me that just couldn’t give her that false hope of a real survival. I wasn’t one of those doctors that sugar-coated death. I decided to be straight with her, just like I would want it if the roles were reversed… just like I had done with so many other families. One would think I was an expert now at giving bad news. I am sure the list of families that I had sat down with to tell them that their loved one was dead – or at least very close to death – was now in the thousands.
I was no expert, I decided. Every single patient was different. Every single family member’s face I looked at with sadness was diverse. So everything I said at each instance was simply from my heart as best as I could say it, hoping to make them understand in normal everyday language, not in doctor talk. It’s a sick, crazy responsibility actually. You sometimes forget because it’s “just part of the job.” I have come to look at it now as a revered obligation. It is never to be taken lightly, no matter what the age, sex, creed or medical condition of the patient. Regardless of any of that, this was a human being that someone had loved.
After I was done breaking the news, I brought her in to see his comatose body. She cried, held his hand and then they were all quickly whisked away to the ICU. And I went about the rest of my day, almost forgetting my Code ICE.
The next day came and one of the nurses who had cared for him asked if I knew how he was doing. Honestly, he had slipped my mind. But there is one thing that I am OCD about. I keep a list. I pulled out the stickered, folded piece of paper from my ChaCha embroidered bag and found his name. I looked him up on the computer not really expecting much. I read through his notes. My mouth dropped open and I read the line again. The patient was now extubated. He was off life support! I couldn’t believe my eyes. Could this be true? Had cooling him down really worked? Would this be my first real cooling save?
I jumped out of my chair and ran straight to the ICU. That’s when I first ran into Adam, the ex-ER nurse gone ICU rogue. He had been assigned to my patient. I begged him to show me the way to his room. I just couldn’t wait to see the living dead man. I should have asked a few questions before I went barging into his room.
The chamber was full of people. A huge group encircled the patient’s bed so I couldn’t see him at first. They were all his co-workers. I later found out it was his birthday that day. He was 52 years old. They were there to sing to him. I pretty much pushed my way through the crowd as I introduced myself as his ER doctor. The group parted in half, as if I was some type of sorceress to be revered. And there he was.
I often wonder if the disappointment I felt was so obvious to see on my face. I wasn’t staring at a living man. I was looking at another vegetable or maybe a zombie. Yes, he was off life support but that was it. He was sitting up in bed and unable to do anything for himself. He couldn’t even look at me when I walked right up next to him. His eyes rolled around in his head like an old baby doll that was being thrown in the air by a child. He was just staring out into a void with involuntarily rotating eyeballs.
What had we done? We hadn’t saved a life. We had only burdened a family. Surely he would end up in a nursing home with some hateful nurse’s aide changing his urine- and feces-soaked diapers.
I said a few kind words to his wife and friends. I quickly let myself out, making an excuse that I needed to get back to the ER. I wished them all well and him a happy birthday knowing his sad outcome. What was I expecting? A miracle? Yes, in fact, I had been. I had been fortunate enough in my career to see many. I wasn’t trying to be greedy but it always helped me feel closer to God. It always reinforced to me that this life wasn’t just a coincidence. I already knew this in my soul, but some days you just get so busy and caught up in the hustle and bustle of life that you forget. I liked being reminded.
I went back to the ER, a bit sad, but knowing we had all done our best to save this man’s life. There was some plan higher than mine at work. I had to believe this dismal survival had happened to help someone. I had no idea that three days later, that someone would be me.
I readied myself and the scribe this time before I reentered his ICU room. I would not be caught off guard again. I am not sure who was more surprised, the patient or myself. I had forgotten I looked like a St. Patrick’s Day green alien. He had the biggest smile on his face as he stared at my green pixie hair.
He could see me! His eyes weren’t rolling around uncontrollably. He could see me! I will never forget that smile as long as I live. It beamed. Without the need for words, it told me how grateful he was to be alive. It was so grand that it reminded me of the Cheshire cat. His teeth were huge. His face seemed so young, so happy.
I had to touch him. I crossed the room slowly with tears welling up in my eyes. I clasped his hand. “I was your ER doctor. And you threw up on me!” He gave a big belly chuckle and replied, “Good!”
I couldn’t stop talking and smiling and laughing. Did he know just what kind of phenomenon he was? Yes, he understood completely. He seemed to be at such peace and so was his lovely wife. “No really, I don’t think you quite grasp this. You were dead for a long time. I have been doing this work for a long time. I have never seen someone recover with their brain fully intact like yours is.” He couldn’t stop grinning.
And then I asked a burning question I had only hoped one day I would get to ask a patient who’d experienced near-death. “Did you see anything while you were dead?” My scribe looked at me like he was sure I had lost my mind. “Why yes, I did,” he replied with the same smirk. “Can you tell me?”
He was happy to share. He felt no pain or fear. He never felt confused as to where he was located. He always knew he was in heaven. He also knew he wasn’t supposed to be there. I didn’t understand but he went on to explain. There was light everywhere but what he remembered most were the streets of gold… glistening peaceful and lovely avenues. He said he recollected looking for Lazarus. He felt they should meet since God had raised him from the dead after three days. Lazarus was nowhere to be found. I asked if he saw any deceased loved ones. He replied no. But he had met someone better. It was God. He said that God had shown him a glimpse of paradise. He had felt God’s loving arms. He had felt unconditional pure love. And God had told him he would return one day but for now, his work was not yet done. He firmly believed that he needed to share his inexplicable story with the world. He knew it was not his time and that there was still a purpose for him to still be alive. Just like there is a purpose for everyone who is still breathing on earth. He knew it. God told him.
He smiled sweetly through his whole story. I listened in amazement. He told me that he might just write a book about it. He knew not everyone would believe. There would be many excuses given for what he experienced. But he knew. He knew it was real.
Words don’t do justice to the awe, bliss, and gratitude I felt for my own life and what I was allowed to see and share. I now completely understood why I had to work that night shift when I loathed the idea. I needed to witness this miracle. It was a gift.
I hugged them both and then quietly left his room. My scribe looked at me as we were walking down the halls and asked, “Do you believe him?” I stopped, looked him straight in the eye and touched his shoulder, “Completely.” I let him know that he had just witnessed something in his early life that I had only dreamt of for years as a seasoned physician. Life is miraculous.
And my attitude was entirely reversed. I couldn’t stop talking and singing and flat out laughing. I let anyone that would listen know about my Code ICE. I wanted to announce it on the overhead pager. Miracles are real! God is real! Life is a gift!
I found a new motto. If a negative thought crept into my head, I would stop and ask myself, “Yes, but did you die today?”
And since I hadn’t, I knew there was a solution and a purpose. I was so happy to be alive. I was so grateful to have been given an opportunity to grow, to make mistakes and to live in awe of this amazing life.
And I wasn’t the only one. Anytime the scribe sees me now, he yells with a smile “Yes, but did you die today?”
And luckily, the answer is always no.
