Death on the Table

I had my first patient die in the operating room.

The call came at near the end of a grueling day. There was an emergency case coming from the ICU. I rushed to set up the operating room. Minutes later, the patient arrived, already the color of barely hanging on. We ignored that, and just went to work.

It was all hands on deck. There were three surgeons, and three of us with anesthesia on the other side of the blue drapes. We worked quickly, giving fluids, hanging infusions, pushing boluses of medications. The patient's blood pressure would drop, down, down, down, far enough down that my own heart would skip a beat with fear that this time would be it. But no. We gave medications, we gave more fluid, and the blood pressure would come back up.

Within minutes after incision, the surgeons informed us that things didn't look good. They didn't think the patient's condition was a survivable one. The plan to was close the incision, take that patient back to the ICU, and talk to the family.

That's when it happened. The patient's heart rate went from fast but regular, and degenerated into a dangerous rhythm. We pulled the drapes down to start CPR. But there was no bringing the patient back this time. There was no fighting death, who had been standing at bedside for so long, there was no fighting him off any longer.

There are patients who are too sick for us to save. And I know that. I know that. I know that! But right at the moment this is happening, when the blood pressure is falling to undetectable, and the EKG tracing is a chaotic scribble instead of a pattern, at this moment, I don't believe it. I believe in this medicine. That this medicine is good, and it's strong, and it saves people. Every day, I watch it save people.

And I know that people die. That we can't save everyone. But they don't die on my watch, they don't die on my table.

Except, now, they do.

Whatever it is that I know, right now I don't believe any of it. What I do believe at this moment goes against everything I know.

There are no more beeps of the monitors. I've shut them all off. It's quiet in the OR, a quiet that doesn't sit well, a quiet that turns and pulls at my insides. I stand there for a while, too long, not sure how to leave when my patient is still on table. But there is nothing else for me to do except to leave.

And now I have to go back to being normal. I have to pull off my mask and scrub hat, change out of my scrubs, and go back to my life. Except there is no going back to normal. There is still the buzz in my head from silenced alarms and the weight in my stomach from the failure of what I believed.