Five days into my emergency medicine clerkship, I had experienced a lot of firsts: My first participation in a code, my first CPR compressions, and my first patient death. This was specifically a code blue for a patient with pulseless cardiac arrest.
An elderly woman was brought in by her family after not feeling well for several days and quickly became unresponsive. As the room flooded with staff, my upper-level resident started running the code and assigned people to critical tasks, including starting CPR, establishing an IV and airway, and placing defibrillator pads on the patient.
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“Evan, you will take over for compressions next.” I verbally acknowledged my role and took my position at bedside, my heart furiously beating in my chest as I tried to recall all of my basic life support (BLS) and advanced cardiovascular life support (ACLS) training. At the two-minute pulse check I relieved the nurse who had initiated compressions and stood over this frail woman who reminded me of my only living grandmother.
So while I read the sentence “I’m so sorry I couldn’t save you” and it speaks what my heart is screaming – it instantly brings me to one of the most horrific, traumatizing moments of our journey. A moment when all of these assumptions were challenged and I was bullied at my absolute weakest.
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I clasped my hands together and held them steady above her exposed chest and waited for the signal to begin; the monitor displayed an electrical rhythm but there was no pulse. While her heart might still be conducting electricity, it wasn’t functioning properly — defibrillation would not help her. The only thing that could save her was high-quality CPR.
“Resume compressions.” A tidal wave of thoughts cascaded over me. On the first day of ER orientation we practiced on an advanced model with visual feedback, and during that orientation exercise, I realized how long it had been since I had practiced CPR.
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But the waves of self-doubt receded and after gentle prompting from another nurse, I settled into a rhythm, with my body and mind completely dedicated to the task at hand. I am a BLS and ACLS instructor, responsible for training other medical students and even residents and attending physicians, and we teach that high-quality CPR needs to be between 100-120 beats per minute or the approximate tempo of the Bee Gee’s “Stayin’ Alive.” The morbid irony of associating that song with this task was not lost on me.
“Two-minute pulse check.” I stepped aside, my mind completely blank. CPR resumed again. My upper level came to my side at the foot of the bed and said, “Let’s go through the Hs and Ts.” In ACLS, the team leader is responsible for directing the group, ensuring effective communication and determining the underlying cause of the problem leading to the code in the first place; the Hs and Ts are a short list of differential diagnoses to consider.
My faculties having returned to me, I assessed the likelihood of possible etiologies: hypothermia, hypovolemia, hypo/hyperkalemia, and hydrogen ion excess seemed unlikely compared to a thrombus to the heart. Clear lungs ruled out a tension pneumothorax but there could be a pulmonary embolism, cardiac tamponade, or a medication overdose. The upper-level resident ordered epinephrine, magnesium, bicarbonate, calcium, among other medication to be administered while someone scanned the heart looking for fluid in the pericardium. There was no specific medical history to point to, and any intervention at this point was increasingly unlikely to bring her back.
In total, we performed 15 rounds of CPR, and I performed four of those 15. During my third round I felt fatigue creep in, and my wrists cramped. To prepare for my fourth round of CPR, I replaced my gloves and attacked my task with renewed vigor, ignoring everything around me except for the beating of my own heart, which I used as my personal metronome.
We tried everything we could to help the patient, but in the end even everything wasn’t enough. The code was called, and she was pronounced dead. The chaplain attended to her grieving family, and everyone who had participated in the code respectfully left the room as she was covered with a thin bed sheet finally granting her body some small modicum of dignity. I was one of the last ones to leave, and after reclaiming my white coat, which I had hastily tossed away I told her, “I’m sorry that we couldn’t save you.”
The dam broke and twin rivulets of tears cascaded down my face as my accompanying intern guided me into the break room where I started sobbing uncontrollably. She asked me what she could do for me, and somehow, I told her that I needed to be alone.
My body almost shook from the exertion as if the release of emotion were more taxing than performing eight minutes of CPR. I didn’t know her name, but from the moment I stood at her bedside to the moment I apologized, she was my patient. And I had lost her.
A few minutes later, I had stopped crying, and I allotted myself five minutes for self-reflection. I then attended the debrief where the code was discussed to ensure closure and to provide feedback for improvement. The consensus was clear; we had all done everything we could, and everyone’s chest compressions were admirable. Ten minutes later, I was at my work station reading about my next patient.
Even now as I recall the case my eyes remain dry until I remember telling her that I’m sorry. I know that as a doctor I will become more familiar with death. I know that this will become easier. I don’t know if I want it to.
-By Evan Schauer, third-year medical student at Baylor College of Medicine
“I’m sorry I couldn’t save you.”
I saw this quote on Pinterest yesterday.
“I’m sorry I couldn’t save you.”
It hit me, right in the heart.
Sorry I Couldn't Save You
It bought tears to my eyes, and flashes of Lulu to my mind.
I am sorry I could not save you.
I have thought these words in my head so many times since she died. This month will mark six years since Lulu died. SIX YEARS. Almost as long as she was alive with us has now passed in time without her here with us. When I say those words out loud, they make my heart beat faster and my throat constricts, just a tiny amount.
Our lives are so different now, to what they were six years ago.
Yet some things remain the same.
July is a time where my senses are on high alert. I am more reflective, there is an increase in flashbacks , memories and remembering. I walk through every July as if it is already scripted for me. I replay the days events from six years ago, as if they are happening again now. I can see the events unfolding before me like some virtual reality game. Except, it is not a game. I cannot remove the mask and walk away. I cannot turn off the computer and take a break.
This is my reality.
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I can hear her voice. I can see her face, as we battled everyday to help Lulu overcome pain, discomfort and the bewilderment in her eyes as her body became a place she no longer belonged. I can see her death in my mind, without even having to close my eyes.
I can see her twisting at her hair, and pulling in out in little balls. A sign of anxiety apparently. To me it was heart breaking. I keep those tufts of hair. I guess that is weird, but I could not bare to throw her hair in the bin.
I hear her cry out, as Andrew and I would lift her into her wheelchair to every morning, so she could spend some time lying in the living room, before heading back to her room in the afternoon for a rest. Was this the right thing to do? She had lost all feeling in her legs and her bottom, she felt unsafe in the wheelchair, she was so scared she would fall. We did it gently and slowly and exactly the same way everyday. I would be in front of her, holding her legs and hands, walking backwards, re-assuring her that everything was alright, while Andrew pushed the wheelchair from behind.
Did we hurt her more everyday for no reason?
I felt like the right thing to do at the time. She was always happy once we got her there. But it felt bad to do it. I could see the looks on family members faces while we were moving her. A combination of sadness, pity and helplessness mixed together. I can still see the faces today. It meant she was part of the daily life of the household. There was no way I was putting a hospital bed in the living room. I do not know if this was a selfish decision or not. All I knew was that I did not want her to die in a hospital bed in my home, which would then be cleaned up and removed. Too much symbolism there for me to deal with. She had her own bed, that she loved, in her own room, which was her favourite place.
Yet, I could not save her.
But this is what I could do.
I'm So Sorry I Couldn't Save You
The sadness from this time is wrapped in the warmth of love. It is held together by a close family working tirelessly side by side to assure the end of my seven year old daughters life was the safest, warmest and most love filled time it possibly could be. It became our job, our only priority and our role.These are my biggest memories from that time. This is what July looks like to me now.
The warmth of a home filled with people, laughter, tears, flowers, candles, good music, soul warming food, cups of tea, reading aloud, held hands, warm hugs and love. The safety of having a nap every afternoon and knowing well wishing visitors would be thanked and turned away. Without me having to speak to everyone who came to our door. The matter of fact sign that was hung on our gate when we were all too exhausted to receive any more lasagnas or flowers and all needed a break. That no matter what I asked of others it would happen. Nothing was too much trouble for anyone, we loved each other in the hardest time of all our lives. And we did it, in my opinion, in amazing style.
Sorry I
So while I knew I could not save her, I could be the best mother for her. I could push aside my fear, my sadness and my breathless anxiety to be the mother of a dying child. Because if anyone could have saved her, I know I would have been the person to do it.