The setting California sun fell into the mountains as my girlfriend and I climbed onto the fire escape to share dinner. In the second month of my surgery clerkship, we were delighted to have a moment to ourselves. As we cleared our dishes, a voicemail from my resident informed me that a patient we had admitted and pronounced brain-dead was heading to the operating room for organ donation. I jumped on my bicycle and soon was running up the hospital stairs.
This patient’s descent was the nadir of my time on the trauma surgery service, a service which carried a diversity of tragedy. We admitted a child who fell from an apartment window, and we cared for a police officer who survived a homicide attempt but was left hemiplegic by the strange trajectories of four bullets. In each of these cases, an emotional distance spared me from the anxiety, dread, and terror coursing through these families. As I climbed the hospital stairs that night, these emotions swept over me, my white coat neutrality breached.
Amidst a cacophony of sickness and pain, this patient resonated with me. He was a promising young professor, brimming with altruism. He had been driving to work on the freeway when one of his tires blew out. He brought his car to a stop, and another car hit him from behind at full highway speed. In him, I saw myself. We both had curly brown hair and a faint olive complexion. Similar ages, similar careers, and the same morning commute. The reality that I would live and he would not shook me.
Out of ritual more than clinical management, I returned to the patient to conduct a final physical exam. The young man lay intubated and unresponsive; I lifted one eyelid and into it I shone a light. The diameter of neither pupil changed. Instead, a dry cornea held a blown pupil that used to belong to someone. I swiveled his head from side to side, and his eyes tracked my movement as if glued into their sockets.
It was 9 PM, and the patient’s family entered the room to say their final goodbyes. In their company, I was overwhelmed by the palpable sense of loss. Medical school had not taught me what to say to those who have lost everything, but human instinct told me to be present and listen. My facial expressions materialized without my control, conveying what I remember as an amalgamation of sympathy and shock. I introduced myself and conveyed my condolences. They thanked me, the sole member of the organ transplantation team present at that moment, for allowing their son to give one final gift. I had not had time to earn their trust, but under these horrible circumstances, they seemed to have made an exception.
Just inside the threshold of the room, I listened to the family pastor recite, “Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me.” I stood with my hands folded at my waist, my forehead trained to the ground, and my thoughts grounded in the utter delicacy of life and how instantly it can shatter. The patient’s father looked between me and his dying son, the juxtaposition between us as apparent as it was senseless and unjust. We embraced, both of us squeezing and holding on for several extra seconds, as his own son lay intubated on the bed beside us. He said my father must be very proud of me and asked me to give him a hug. I told him that I would, and we hugged again.
It was approaching 10 PM, and the organ recipients were undergoing general anesthesia. As the prayer concluded, the anesthesiologist, orderlies, and I wheeled the patient out of the intensive care unit; machines, medical staff, and family all orbited him in his last hour of physiologic life. I was entrusted with ensuring that an IV stand remained adjacent to the bed, and I gripped the metal pole like a vise. There was silence, and at a glacial pace, we solemnly rolled the patient through the deserted hospital hallway towards the doors of the operating suite.
As night progressed into morning, I witnessed a display of the greatest miracles of scientific medicine. I saw our patient’s lungs inflated like a set of football shoulder pads, carried off into the next room, and transplanted into another patient. I assisted as our patient’s heart was stopped, clipped from his chest, and sewn into a third patient, where it began to beat again. Yet, the image that I remember most vividly is my last glimpse of his family as we passed through the doors to the operating room.
It was a night I have thought about often in the many months since. As I mature as a physician, I anticipate that the face of death will become less foreign and tragedy less jarring. With time, stress, and repeated exposures, my emotional response to such tragedy will likely wane, but I doubt my memory of this patient and his family will dim. Their memory will always, for me, be a source for empathy and a stark reminder of how painful loss can be.
Jacob Rosenberg
J. Rosenberg is an MD/PhD student, Stanford University School of Medicine, Stanford, California; e-mail: [email protected]
