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Journal of the American Academy of Physician Assistants:
doi: 10.1097/01.JAA.0000431504.93003.e3
The Art of Medicine

Fathoming the unfathomable

Godfrey, Alexandra MS, PA-C

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Alexandra Godfrey practices emergency medicine at St. Joseph's Mercy Hospital in Ypsilanti, Michigan. This article is part of the Emergency Medicine Notes collection of the Art of Medicine.

A dim light glimmers in the water, marking the pool's end. Sea green tiles on the pool floor count my progress; I am 32 laps, 14 drills, and many thoughts in. Images of patients float in and out of my mind: a sweet scented baby, a body in a parking lot. I try to fathom the unfathomable. As I near the pool's end, I exhale sharply, flip and push my feet off the wall. I feel the cold splash of the water as I start lap 33. My warm body against chlorine cool reminds me of other contrasts and contradictions between hot and cold.

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The mother runs her fingertips along the soft curve of her infant's rounded cheek; then lets them settle on his dusky bottom lip. “My baby feels warm. He's not gone. Is he really dead?” she asks.

The still baby makes no sound. A small, silent form amidst the noise: a monitor beeping, a drunken man singing, a child crying. The baby died before he got to us. Everyone tried to save him. Really he was dead on arrival, but no one wanted to give up. The pediatrician called it in the end.

I see the quiet tears of a nurse who brings a wooden rocker, the mother scooping up baby to touch his ashen face gently to hers, and the social worker searching frantically for an ink pad. Dad wants imprints of his son's sole. Dad asks the doctor how his infant can be gone. Someone talks about SIDS; another quietly questions child abuse; some look to the heavens. Later, two tiny footprints leave the ER. The child cools alone in the morgue. A nurse murmurs, “He went to a better place.”

I consider this as I pull toward the light at the end of the pool. With my palms backwards, arms over, and feet together in a vital dolphin kick, I breathe with the undulations of my body. I fly through the water, building my strength and pushing myself harder with each stroke. The water splashes as my feet plunge in and out of the pool. I find peace in the synchrony between my mind and body. I decide medicine is full of incomprehensible moments; life sometimes fulfills and sometimes kills.

In the sun-drenched hospital parking lot lies a dead man in a half opened body bag. I swelter in the heat as the sun's rays glance off the gurney. The scene seems surreal. A coroner's truck idles to my right. An ambulance rig screens us to the left. In a tree nearby, a squirrel chatters.

The man died on the pavement of the interstate. His mouth gapes open in a wide “O,” as if death caught him by surprise. His crushed forehead and broken jaw hint at cause of death. His left leg is snapped at the tibia, and the bone protrudes through his skin. A clean, white terry sock remains on his right foot. The sock perturbs me; otherwise I feel nothing. The man is here for a blood draw.

An EMT was exposed to the man's blood at the scene, and the coroner requires his blood. I attempt a subclavian; nothing. With help, I place an IJ, commenting it matters little if we drop the lung. This time, I get it right; blood streams out of his body, running warm from the cool corpse. Warm? I wrap my fingers around each tube, acutely aware I hold the last of the man's life. Who was he? What would he say about this? Did he suffer? When I place those warm vials down on the chilly counter top indoors, I hesitate.

I play catch-up in the pool; one hand chasing the other, forcing each arm to grow stronger. Lap 72 completes my swim. I feel rejuvenated as I lift my body from the water and stand in the warmth of the morning sun.

Medicine does not always make us feel comfortable. Sometimes we witness incredible loss and see unimaginable trauma. Often we hurt with our patients and their families, but our work requires us to support and sympathize to give them strength. As clinicians, we keep moving forward, seeing patients, striving to reach new and tougher goals. At some point though, most of us need to stop for a moment to come to terms with these experiences so they enrich rather than diminish our appreciation of life.

© 2013 American Academy of Physician Assistants.

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