It is our humanity that will set us apart. It is what is memorable to those around us, what is lasting, and what we will carry with us to the end beyond any skills or physical traits. It is also what will temper your memories, save your sanity, and preserve your soul from the sights and sounds of those walking through the worst moments of their life.
I can still hear her… “Mommy!!!! Where’s mommy, where is my mommy? I want my mommy” She’s there when I close my eyes, lay my head to sleep, or even look at my own young son. Her words, her voice, her raw unrelenting emotional fall are part of my soul now, and even if I wanted to shed this memory and throw away those feelings they are permanent.
A four-car wreck, a small unremarkable totally forgettable county road and sunset burned into my mind. It was like a scene out of some horrific film had played out before me. Bodies and metal twisted into a bloody singularity everywhere I turned. Five lives traveled with the ferryman that night and there was nothing anyone could do, they had already paid their two gold coins and were gone before my arrival. We compressed, we intubated, we forced fluids in at a break neck speed only matched in urgency by the engines on the ambulances as we sped away.
I had returned to that horrible scene for the second time as I knew there was more to be done. But, as I walked back up to the car, the same one moments earlier I pulled a lifeless beautiful young girl from, I heard her, I heard those three words that have never terrified a grown man like they did that night. “Where’s my mommy?”… I had just left mommy in the trauma bay, and she was so very dead.
I scooped up this little angel and hugged her. I held her close to me shielding her eyes as I walked from the wreck. She couldn’t have been more than 5 or 6 years old. I sat down on my own stretcher in the back of my ambulance and strapped her in with me. The others on scene were taking care of those that were left and something just felt like I was needed here more. Strangely I had no idea of what to say or what to do. I had danced with death so many times before, I should know these steps, I should know what to do, what to say, how to help this fragile young beautiful soul through this. I was lost though, my mind was blank and all I could do was sit there and hold her tight, repeat totally worthless phrases like “it’s going to be ok sweetie”, and play the stupid games I always did with kids that ended up in the back of my truck. I didn’t know just what to do, or just what to say.
A latex glove will make a great balloon animal if you practice enough.
I sat in the ER room with her for hours just so she wasn’t alone, watching Looney Tunes on my smartphone, sneaking in juice boxes, and sending my partner out to get us a hot chocolate and coffee though I am not sure whose soul that was more for, hers or mine. Family was finally notified and a grandmother finally showed up and sat down to hold and cry with her. I walked away without a word, without saying goodbye, and without knowing whether anything I had done that night had amounted to anything.
These terrible scenes are sort of expected in EMS I guess so it’s probably not too shocking to think about happening. Yet, when you live the medical life you never know when you will be confronted by some event, some scene that quite frankly will be a defining, life changing, dose of reality for those around us or even ourselves.
Years later I walked into my preceptorship site during the first year of medical school. I was looking forward to being back in the clinical world. In school we spend hours hidden from reality, days upon days of our lives seem to slip away sacrificed to knowledge. Books become our cohort and strange names whispered only in sterile unfeeling halls become our only friends. Kawasaki, Duchenne, Arnold Chiari….. each well known to me, I can tell you the intimate details of their lives just like my own kids.
When were their birthdays again?...
Spirochetes, chromoblastomycoses, pseudomonas…
So any time in “the wards” felt like a treat at this point. As you may have surmised from the previous tale I was not completely wet behind the ears and probably a little more confident then I should have been, but I felt my old skills start to flow back.
Assesments, IV’s, ECG’s, a snotty nose some vomiting, fever, fever…. I got this.
My head swiveled around, surely he wasn’t talking to me, my coat was way too short for someone to call me that.
I walked in to Exam 21 and was met by a smiling middle aged gentleman who looked fairly healthy; though his skin had the deep leathery tone of a man who had worked outside his whole life and smoked a carton a day.
“I know I just got brought back here but I really could use some oxygen.”
I peaked at his chart, he was here for a progressive cough and overall just feeling weak and crappy (that’s the technical term). I put him back on his oxygen and sat down to interview him; since I was already here why not. Exam 21 was hilarious he had lived everywhere, done everything, and kept smiling even when his breath ran short and I had to rein him in on talking so much. I finished up and told him I’d be back after I went and talked to the “actual physician” and get things rolling for him. He smiled said “thanks doc, you’re good people”
I ran my assessment and plan past my attending and he signed off on it. Some x-rays, a breathing treatment, and some labs. Nothing too much just another chronic lunger needing a boost.
The day spun along just as it had, fever, hypertension, chest pain… I got this.
Then my computer screen flashed.. Exam 21’s x-rays were back.
What the heck is that? No. No. No. come on.
My attending leans over and stares along with me, we both go back through his labs, we both pull up any past charts we can. I don’t think either of us wanted this to be new.
After much discussion I told him that I would really like to be the one to talk to the patient, I mean I couldn’t hide when the job wasn’t fun, that wouldn’t make me “good people.” I am sure my attending was hovering right outside the curtain to save me if needed as I walked back in to Exam 21.
“Hey Doc.” he was smiling ear to ear… “that breathing medicine sure did help, can I get on outta here I have to work tomorrow.”
I sat down next to him on the bed and laid it out there. Your x-rays look bad, and it looks like there is more going on than just your COPD. It concerns me enough that we want you to follow up with someone. I don’t like to scare people but I don’t like to beat around the bushes, it could be several things but one of those things is cancer.
The smile faded from his face… “well damn….hmmmm… damn”
I flashed back to that young girl and I felt lost and didn’t know just what to do or just what to say. I just sat there, I patted him on the back, and we talked for about another hour. Mostly about everything but what I had seen on the x-ray, but every once in a while he would ask a question that I could constructively answer. I helped setup a follow up for him, I helped get him a few prescriptions to keep him breathing well, and I helped explain things to his now terrified wife when she showed up from work.
He packed up his stuff and they began to leave but as he walked past me headed for the door he paused, grabbed my hand and pulled me in for a one arm hug. “You’re good people doc… good people.”
I didn’t really feel like good people, I felt more like a horrible person, almost like I had caused that deep dark shadow to appear on his x-ray somehow. I felt lost, I didn’t know just what to do, I didn’t know just what to say.
I walked out of Exam 21 drained, I imagined I looked visibly weakened as the nurses who had known me for years asked me if I was ok….. I lied.
Medicine waits for no man though, so I was back to it. Fever in exam 14, ok I got this. I walk in through the curtain and there sits a young almost teenager with a much older looking lady sitting next to her. She looked fairly healthy but definitely tired; like you would expect someone with the flu would. Suddenly though, before I could say a word the girl begins crying. Not just a little as if from discomfort but forcefully as if some emotional valve had popped.
Wait a minute… Why do I know this girl….
With almost enough force to knock me over she was on me, wrapped around my waist hugging me tightly, sobbing. “Thank you, thank you, thank you… I never thought I’d see you again.”
It was her, as sure as I live and breathe it was that beautiful young angel who had sat with me on the ambulance stretcher playing with the glove balloon animal those many years ago when the world had seemed so small and I had felt so lost in my lack of medical skill to fix her problem.
“I never got to thank you after that night, I never knew your name, but it’s you isn’t it? I’d remember you anywhere.”
I didn’t need to clarify to be sure, I knew she was right and that somehow fate had crossed our paths again. I sat down and we just talked. I sat in there long enough my attending poked his head in to see why I was taking so long on a patient with flu like symptoms.
She told me all about her life, and everything that had happened since. She told me that I helped her, and that she remembered everything I had done that night. She told me I had helped her by just being there and by just being me.
We got her worked up and taken care of for her flu. I got her paperwork together and gave it to her grandmother. I hugged her again and sent her on her way with a strange smile on my face.
When the day was over I drove around for a while, I needed to wind down before switching to dad mode. I thought about what it was that I was doing, that all my friends in medicine are doing, our time squirreled away in books and the time swarmed in the clinic. I thought about what I should take away from it all and what’s important.
The skills and knowledge we spend days upon days learning and refining are invaluable. It’s like someone preparing for battle you don’t simply strap on the gear you need for the expected, you take the gear you will need if the worst happens. If you walk in only prepared for what you had hoped for you’re going to lose. This base, this knowledge is one of our primary charges, so gear up learn everything you can for you never know what random piece of knowledge may save someone’s life. Yet there is more to it than that.
I have been in medicine for a long time now and I have worn many different hats through this journey. I have seen literally thousands of patient’s, saved lives, brought lives into the world, watched death slowly wash over people, and seen life yanked away so quickly you would expect to see their ghost walk right past you if you looked up. Through it all though my internal defenses have made much of it a blur, but what I do remember the most vividly, what I feel has truly added to me as a person and where I might have made the most impact is the moments where I wasn’t an EMT, a Paramedic, or even a Student Doctor but the moments when I was just a human. I hope Exam 21 follows up on our findings, I hope he manages it all with that smile, hell I hope we were wrong. More than anything though I hope that maybe just maybe those few moments I spent just talking and being another human with him might have helped in some way like it did with the young girl.
It is our humanity that will set us apart. It is what is memorable to those around us, what is lasting, and what we will carry with us to the end. It is also what will temper your memories, save your sanity, and preserve your soul from the sights and sounds of those walking through the worst moments of their life. I pray that all of you that are on this journey, through what I call “The Medical Life”, with me regardless of what hat you wear remember this and cherish the opportunities we are given to share ourselves as humans just as much as our knowledge and skill.