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This week in doctoring, we talk about breaking bad news. How to tell someone that his or her loved one is dying or is dead. We hear heartbreaking stories from parents of dead children, of organ donors, and of heroes. Their sorrow seems so palpable and fresh despite the years that have passed that we can’t help but listen transfixed, rooted in their stories. On the other hand, we also hear uplifting tales from organ recipients, from doctors who are also patients, and from people whose lives have been saved and irrevocably changed. Never has the line between the finality of death and fragility of life seemed so close.

emergencyOn a Tuesday afternoon, the ER is packed. Our clinical reasoning elective mentor is busy with getting caught up as he is just starting his shift so we ask the attending signing off if there are any cases that would be good to visit. “There’s a burn patient coming in. You should definitely see that,” she tells us. I watch the bustle of the resuscitation bay of the main ER as paramedics cart the patient in.

I don’t know who he is, how old he is, or even what his name is. But his body is covered in burns. Even watching from afar, I see that his skin is an angry red, sloughing off in chunks. I’m no expert, but it looks bad. “His burn surface area is 45%, which we estimate using a 9 by 9 by 9 rule”, an off-duty attending explains to me. I can’t imagine what that must feel like. I hope he’s not awake I think to myself.

“We found him rolled up in a blanket and he was covered in burns,” the paramedic explains. “There was a bonfire outside. It smelled like kerosene.” The room is crowded with lots of people in multi-colored scrubs. Everyone is talking. Space is limited. Who is in charge I wonder? And even more people come in.

I watch the screens beep as the patient’s HR increases. The resident is intubating the patient to secure the airway. The screen then beeps with alarms and I feel as though time has stopped as the patient’s heart rate drops to asystole. The resident immediately starts chest compressions. It happens so quickly that I barely have time to blink. Someone else (maybe an attending?) switches over to do compressions too. Perhaps it is only then that I realize that death is a possibility. “We need more people to do chest compressions – med students.” All of a sudden, I am no longer just a spectator.


Empty room in the ER

“I have a pulse,” the resident calls out before we can even find gloves, which are difficult to find when you actually need them. I don’t think I’ve ever been as relieved. He’ll be okay, won’t he?

It’s strange I know, but I always think of death occurring elsewhere. The patient with ovarian cancer or the patient with heart failure who is at the end of line treatments. Yes I’ve met them, but they’re alive when I see them you see.

Eventually I imagine I will have to face death and perhaps my own limitations. It is a frightening concept, but a very real and universal part of doctoring – or so I’m told. But, at least not today. I don’t know what his end outcome will be. No doubt his path to recovery will not be easy. Life and death are held in a delicate balance.

Nonetheless, he’s alive. And for that I’m thankful.

*** The details mentioned in this post have been modified to protect patient confidentiality.***