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Excerpt
I realize that my jargon-laden terminology fails to convey the full horror of this sequence of actions as I experienced it. The first patient that I admitted to the hospital as an intern, a man suffering with an acute crisis of diabetes and its complications, died this way. I wasn't present when he was discovered pulseless and apneic, so others initiated the resuscitation attempt. Hearing the emergency page, I hurried up five flights of stairs to his room, but arrived after the resuscitation attempt was under way. Before we finished, he had an endotracheal tube, a subclavian line, multiple arterial punctures, and a crudely opened chest. I was covered, like others, with electrode paste and blood. When—for pity's sake—we stopped and stepped away from his bed, there was a sudden realization that we had mutilated his body as well as brutalized all the other patients in the four-bed room. Struggling to breathe, I left the room and took refuge behind the linen carts in the ward staff unisex bathroom. I stepped inside for solitude, only to find the charge nurse there and in similar distress. After a good cry, washing up, and a long hug, we were both able to come out of the closet.
When that patient's family arrived hours later, to view his body and discuss an autopsy, I was unable to speak with them. I was busy—but I was also ashamed and guilty. I knew that I had failed in my responsibilities to care for this patient in the only way I could after his death—by attending to his family in their grief, standing with them at the bedside, answering their questions, and speaking together of his life and death. At that moment, I knew that I would never cut open a chest again to engage in a useless attempt to raise the dead. Within the next two years, the practice fell into disfavor anyhow, when its futility became apparent.
Over the course of my internship, it was the nurses who taught me how to prepare myself, as well as the patients I had lost, for meeting with the family. I learned to stay after a patient had died to remove the tubes, needles, adhesive tape, and IVs. I would help to wash the body, change the sheets, compose the limbs, and close the eyes. I would walk around the room and talk with the other patients, asking them if they were all right and whether they would prefer to leave before the bereaved family entered, knowing that they would be separated only by thin curtains from this passage. When at all possible, I would move the body to another single room so that the family could have space and time as well as their privacy. Then the family and I would meet, talk, plan, and say goodbye. Then I could hold my head up. Then I was once again a physician.
