I was halfway through a busy day as an ER technician when the charge nurse told me to report to Trauma Bay X to help with CPR. I walked fast, knowing my initial view of the patient would be shielded by the overwhelming number of providers who appear during codes. I squeezed my petite body through the blockade of people only to arrive upon an unexpected sight. The patient was a healthy-looking woman under forty years old, a complete contrast to the patients I usually see in cardiac arrest.
As I started what would be the tenth and final round of CPR for this patient, the nurse beside me explained the case. The patient had inhaled smoke in a house fire and WALKED into the ER, two hours ago, complaining of shortness of breath. Then, she suddenly collapsed into cardiac arrest.
When it came time for a pulse check, I slowly retracted my hands from her chest and prayed for the sound of a restarted heart. Instead, the words “No pulse detected. Time of death 00:00” reverberated in the room. A moment of silence was then given for this patient, which was interrupted by a loud scream. I jolted, expecting a distraught family member to be in the vicinity. I turned, only to discover an empty void at the source of the scream.
I stayed in that trauma bay even after most of my team left, looking for who screamed, looking for an explanation, looking for meaning in this undeserved event. Within that trauma bay, I was trapped in a liminal space, fully aware that unexpected death is inevitable in medicine, but hesitant toward becoming sensitized to it.
Now, three years removed from this experience and a current medical student, I found the source of the scream I heard in the silence. It was an internal part of me. An internally derived scream that served as a defense mechanism at a time when I could not accept the death of a young woman. I did not want that moment of silence for my patient. I wanted a noisy healthcare team that found a pulse on her and allowed her life to continue.
The screams I heard in the silence got quieter over time as they made an asymptotic progression towards being fully extinguished. I often debated if the quieting of the screams was a symbol of my acceptance of death. Death did not become easier and in some cases, not even more understandable. The difference lies in my appreciation of those moments of silence.
The moments of silence that signal a patient’s passing from one world to the next.
The moments of silence that show the limitations of medicine and force me to find meaning in some of medicine’s greatest mysteries.
The moments of silence that fully humanize me and cultivate the strength I will need as a future physician.
St. Louis, Missouri