I lost my first patient tonight. I’d been present at a final code once before, but that was hardly my patient, and the family had been expecting relief from his hard fought battle with cancer for some time.
This was different. Mr. Trauma Focus (all the male patients without names get a car code name when they arrive from the ER, and though I know his name now, I’ll remember him this way) came in as a level 1 trauma motor vs pedestrian accident. I was there when we intubated him, I was there when we opened his belly and packed his wounds with lap sponges. I found additional injuries during his transfer. I preened in the angio lab, after surgery, when Dr. Tyroch, the chief trauma surgeon asked me what I did before med school and complimented me on how helpful I was in the OR.
I waited by the patient’s side as we embolized three arteries to stop more bleeding and added a filter to his largest vein to prevent clots from reaching his lungs or heart. I listened, amused, as the interventional radiologists finished their work with the oft quoted signature, “another life saved!”
And then he coded. We couldn’t find a pulse in the angio lab. So we infused more blood and hurriedly transferred him to ICU. Over the next few hours, in spite of our best efforts and his, Mr. Trauma Focus slowly lost the warmth from his body, along with copious units of blood. His systolic pressure had been below sixty for more than an hour when his pulse suddenly dropped forty beats per minute, from 112 to 67.
I told my resident, and asked if we could fetch the family. As she rose from the nurses’ desk, our patient started to code. This time, he didn’t come back. After five minutes of chest compressions with no response, the code was called. We informed the family. His son began sobbing violently while his wife stoicly comforted her child and told us they would wait for the other children before viewing the body.
I wonder at her resolve, in the face of death. Were they religious people? Did she hope for a reunion at resurrection? Or was she just in shock, and doing what had to be done until she had time to process it all?
Sometimes, rites of passage come when we don’t expect them. Mr. Trauma Focus certainly didn’t expect to walk out of the bar and get hit by a pickup truck. I didn’t expect to lose my patient tonight. Not when I came on shift, not when he arrived, not after surgery, and not during angiography. It feels numb, and solemn. Two hours of sleep before morning rounds.