The rhythm of life and death: One physician’s experience
January 10, 2018
Dr. Justin McAllister, an emergency medicine physician at Sunnyside Medical Center, shares a personal story about a patient who nearly died and came back a year later to thank him for saving her life.
In the background of the controlled chaos unfolding in Room 1, the monitor chimes; beep-beep-beep in cadence with the two hands poised over the breast bone. Below these hands is our patient, who is on the cusp of death and may in fact have already crossed that line. Our work is to save this person, this mother, sister, wife, friend, fellow human.
Beep-beep-beep, the rhythm continues. Two minutes have elapsed but it feels like an eternity, an eternity to search my mind and experiences for answers to the question of why this person’s heart has stopped.
“Pulse check,” I mentally snap back to the room as the primary RN announces the time. I place my hands on the patient’s femoral artery. Nothing, no pulse. “Resume compressions, 1 mg of Epinephrine,” I order, and we continue.
My team works like a well-oiled machine. The registration team has placed the patient information in the computer. The primary nurse records the data and tracks time. One technician performs chest compressions while the other hooks up the monitor. The secondary nurses start IVs, hang fluids, and give lifesaving medications. The respiratory therapist controls the ventilations and oxygenation with their bag valve mask. The social worker consoles and comforts the family, and the rest of the team stands by as needed. The paramedics have already started this precious work and hand off to us so we can continue.
Fighting For Life
Beep-beep-beep, multiple rounds of CPR and medications march on for what seems like hours. “Pulse check” is called again. I place my hands on the patient, thump, thump, thump. The femoral pulse bounces my fingers up and down as the patient’s heart resumes its life-giving function. The monitor beeps in a steady but now changed rhythm as the patient’s own heart takes over. After a few more minutes and some phone calls, the patient is whisked away to the Intensive Care Unit where the work for life continues.
My team dissolves back into our roles in the Emergency Department. Our patients will inevitably ask us why it took so long for us to see them or why there was such a delay in their stay. We dutifully apologize and continue our work with the rhythm of the compressions fresh in our minds.
This scene plays out over and over again in hospitals and Emergency Departments around the world every minute of every day. Ours is the profession of death, and of life; of close calls and near misses. It is in our hands that this balance plays out. Too often death prevails; however on this day, life prevails.
Fast forward one year. I am working my shift in the ED as usual and the charge nurse says someone in the lobby has asked to see me. In the corner of the waiting room two frail elderly ladies sit holding a box of fresh cookies. I walk over and introduce myself, take a knee, and ask what I can do for them. The smaller of the two says, “Dr. McAllister, you may not remember me, but one year ago today I died, and you and your team brought me back to life.”
Moments Like These
A flood of emotions cascades over me as I embrace her with tears in my eyes. We talk for a few minutes, and I resume my work with a box of cookies, a handwritten card, and a full heart.
For those who are not familiar with emergency medicine, it is a rare day when you get to know the full fruits of your labor. When you get to see that what we do matters. Our patients are often out of our department before we ever see recovery or improvement.
We undergo four years of undergraduate training, four years of medical school, and four years of residency. Countless sleepless nights, and thousands of hours of reading, studying, and listening to lectures. And for what? The answer is simply, for moments like these. Moments when you know you have truly altered the course of a life. The moment I embraced this woman in our lobby when, just one year ago, she was 100 feet away in our resuscitation bay, for all intents and purposes dead. It’s for moments like these that I continue to come back, and that keep us all going.