‘You're a great doc,” my patient said, right before leaving with his discharge papers.
It caught me off guard, but put me in a great mood for the rest of the day. In the ED, compliments seem few and far between. Just a few words or even a single word can change everything. This leads to a story that happened recently in my ED.
I have become numb to the cacophony of ringing, beeping, and dinging throughout the emergency department, with one notable exception—the panic blare. This alarm has a distinctively grating quality that appropriately gets my attention because it indicates that a staff member needs immediate assistance.
I got up from my desk and hurried to the triage area where the locator indicated the problem. When I arrived, I found two triage nurses with an unconscious patient lying on the floor. She had passed out just a few seconds earlier.
We checked her pulse. Then we started CPR.
She was young, though my definition of young has continued to drift through the years. I define “young” as anyone under 50, but that number changes regularly. We continued CPR as we transported her from the triage floor onto a stretcher and moved her immediately to the trauma bay.
“What happened?” I asked, trying to gain information about why the patient had collapsed in triage.
“Not sure,” the nurse responded. “She came in feeling short of breath with some chest pressure, and then she just collapsed.”
“She was talking?” I asked.
“Yeah, she looked OK at first, but then she became pale and passed out,” the nurse said.
She had driven herself to the ED, and no one was with her. We had no name, and the staff searched for identification to obtain any sort of information pertaining to what had happened. We continued our algorithmic ACLS protocol. IV access was established. Medications were provided. Compressions were given. We did everything we were trained to do. But she died. We all felt terrible.
We have all been there, but I could tell my nurses who had spoken with her in triage felt especially miserable. They felt the loss more acutely than the rest of us.
The ED is in constant flux. One minute we can be charting, chatting, or sipping coffee, and then we have to change gears in an instant and sprint into a life-or-death situation. Such contrast should not be normal for anyone, but it comes with the territory for us.
Just before I pronounced the patient, I took a moment to say her name and pause for about 15 seconds. It was a short, respectful reflection to realign as staff and allow for the gravity of the fact that a person had just died. We acknowledged that someone who had been alive just moments earlier was no longer with us before we rushed back to the “normality” of the ED. Sometimes returning to work comes easily; sometimes it does not.
All of us have learned to detach ourselves from our patients. We do this to protect ourselves. The emotional scars from regularly dealing with a multitude of the sickest of the sick take their toll.
Change a Life
I have thought a great deal about why I can pronounce a patient and return somewhat easily to my shift in some cases, but this can utterly derail me in others. The death of any child or anyone I have spent significant time with causes more emotional trauma, especially if the patient has spoken to me.
Even if a patient has said just one word to me, it changes everything. Communication changes the relationship. Of course, I have had patients who came in unconscious and had that rip me to my core when they died. Usually, though, the ones who really take it out of me are those who come in talking but subsequently die. If a patient has said a single word to me, it seems more real.
Perhaps this is why we need to strive to communicate even better. I always try to have patients talk to loved ones before an intubation. We never know what will happen. The effect of a single word can forever change a life.
The shift continued.
Later, we had a short decompression with the staff about what had happened. I told them they had done a great job, and that it went as well as something like that could ever go. Sometimes giving compliments and being kind seem to take significant effort.
Say the words. Be the one to spread kindness. You may never know how much a single word may change a person's life.
Dr. Brandtis an emergency physician with the Grand River Emergency Medical Group in Grand Rapids, MI. He was the winner of the 2008 Writer's Digest Short Short Story Writing Competition (http://bit.ly/1kIBaOf). Read his blog and other articles athttp://brandtwriting.com, follow him on Twitter@brandtwriting, and listen to his humorous ED podcast, “EpineFriends,” which can be found athttp://apple.co/3d9Nco2. Read his past EMN columns athttp://bit.ly/EMN-BrandtsRants.