It was a grim night. A man had stumbled, drunk, into the street and been hit by a car. The car drove off, but bystanders called 911. The man was strapped to a bright yellow gurney and brought to the emergency department in an immaculately clean ambulance. He himself, however, was disheveled, soiled and violently combative. He fought. He yelled. He spat. He smelled. He was disgusting.
Everyone deserves good care, thought I. My evaluation found him to be merely drunk. I considered imaging studies, but they would have required general anesthesia, which didn't seem advisable given the man's condition. Instead, I admitted him for observation. I got to sleep about midnight.
An hour later, a nurse woke me to let me know that my patient was unresponsive, breathing shallowly and had dilated pupils. The black-and-white CT images that I ordered immediately revealed what I already knew: blood in the brain. Damn, I thought. I should have gotten that CT hours ago.
There was guilt. There was panic. The neurosurgeon at our referral hospital was groggy and irascible on the phone. Eventually, the same ambulance that had brought the man in returned and took him away, on the same bright yellow gurney. He left my care in critical condition. He later perished.
I had failed the man. He had lost his life. In retrospect, I could think of several medical errors on my part that had led to this “adverse outcome.” Even my resolve to never repeat them brought me little solace. I felt incapable and uncaring. I was hollowed by shame. In the horrid remains of that night, I haunted the halls of the hospital, forlorn. The emergency nurses tried to find the man's next of kin, but none could be found. There was apparently no one to claim him as theirs. My relief at this fact, given my fear of litigation, only added to my expanding guilt. In the end, I was left with enduring guilt and a vivid memory of the man. He had lost his life and had no one to mourn him.
Yet surprisingly, I have since found that not to be entirely true. Judging by the sadness I’ve observed in myself around the memory of this man, I myself, by some small measure, have mourned him. Somehow, through it all, despite myself, I evidently had become a little attached to him. Remarkably, it is in this modicum of distant grief that I have found the most solace…and even life.