Saturday, June 5, 2010

Thoughts on Death

You see Dr. Wen in there? He's explaining to that family that something went wrong and that the patient died. He's gonna tell them what happened, he's gonna say he's sorry and then he's going back to work. Do you think anybody else in that room is going back to work today? That is why we distance ourselves, that is why we make jokes. We don't do it because it's fun, we do it so we can get by...and sometimes because it's fun. But mostly its the gettin' by thing. - Dr. Cox

Morbid humor abounds in the ER. Dr. Cox had it right; we laugh because we don't want to cry.

When the patient is a young person killed at the prime of his life by a come-out-of-nowhere accident, it's not funny. It's not funny to run a massive resuscitation on someone younger than myself. It's not funny to run out of room on the trauma documentation paper because there are just too many injuries to list. It's not funny to have to untwist the arm because it's broken in a dozen places. It's a little bit funny when in the midst of calling out the injuries to the RN documenting, the doctor calls out "and he's got a stubbed toe too."

Really, it's not funny when he dies. And it's definitely not funny when you have to explain to his family what happened tonight. But then we leave the room, and we all take digs at the primary RN - we'll call him D - because this is his second patient of the night, and he's killed them both. Or so we joke. Because in actuality, they were both dead from the start - we were just trying to hold off the inevitable.

A little bit later, a sweet lady comes in for chest pain. EKG is normal, troponin is up. She is moved to a trauma room because someone just has a feeling. We tell D he can't come into her room because we like her and don't want her to die. Everyone laughs, because that is funny. We're joking with sweet lady while we get her comfortable. When we roll her to change the sheets, she gives me a hug. "You all are just so wonderful," she says. We all smile and secretly hope for the best.

Sweet lady gets back from CT, and her heart rate goes from 110 to 85 to 60 to 40 to 30. She gets an atropine to bump her back up. Whew. Then D sticks his head into the room to see if we need help, and she codes. Not funny.

And then the soft spoken, very kind ER doc, in the midst of an Integrilin, amiodarone, epi and atropine and compressions and shock her 15 times kind of code, looks over at D and says, "D...get the f**k out of this room!"

We all giggle, because that's funny.

And then it's change of shift, and I'm heading home. Young trauma is in the morgue. Sweet lady's friend is crying in the consultation room. I walk down to tell the nurse who initially had sweet lady all about what happened. We laugh at the fact that D only had 3 patients tonight, and killed them all. We call him Grim Reaper D and tell him to take a vacation tonight.

But really, it's not funny.

Because three people died tonight, and there was nothing we could do to stop it.

I cry in the car on the way home.

And now I'm here, and I'll eat a bowl of cereal and go to bed, because I'm back to work tonight. And people will still be sick again today. Life goes on.


Kelli said...

Wonderful post.

Anonymous said...

In private, my friends and I call this, being Dr. Death. We know it's not funny; it's survival.

Kaley said...

sweet LP.

lisa said...

we've all been there.....good post.

tp said...

wow. wow, wow, wow.

Anonymous said...

trying to laugh instead of crying is good, but I feel for the poor Dr called Dr Death. Whats he got to laugh at?

Nurse Me said...

Yup, yup. It's not funny. Except when it is. And even then not so much. Laughter through tears.

Intubate Em!!! said...

I love this! It is all so true. I extubated 3 people in one day so they could die. So for the longest time, the nurses in ICU called me their angel of death. It's funny to me, but when I think about it, it makes me sad. I don't think the families of those 3 people think it's funny.

The things we do to cope....