Unanswered Questions

I don’t know you but I watched you die. And then I watched the code team bring you back. Once, twice, a third time. I heard your voice as you cried out in pain when the electricity surged through you. I wondered what else in your life had made you cry; what had made you laugh? Were you conscious in those final moments, as we pumped your veins with medications and strapped your chest with wires? Were you aware of what was happening? I hoped not, for your sake.

You had arrived to the emergency department a few hours earlier. You made a joke about your disheveled appearance, dismissed your fall as a bit of clumsiness. Now, your weathered, brittle skin clung to your thin frame, your sallow chest heaved in and out with every breath. How had things changed so quickly?

When the senior physician decided you needed help to breathe, we moved you to the acute area to intubate. Everyone else slipped effortlessly into their assigned roles to help you. I stood there paralyzed in fear and confusion. How were they all so calm? Were they feeling the same panic, but just better at hiding it?

“That’s a great example of head-bobbing from aortic regurgitation,” a resident said quietly, encouraging me to take a closer look at you. As a medical student, I didn’t know whether to thank him for acknowledging my presence and trying to teach me, or admonish him for reducing your pain to a physical exam finding. Part of me longed to be able to emulate his composure, but I was terrified for you. My tears began to well up behind my eyes. I needed to distract myself, to find some way help you in a situation where I was feeling helpless.

I heard someone ask if anyone had contacted your next of kin. Recognizing my chance to help you, I checked your chart, looking for contact information. You had listed a friend—your landlord, I think. I grabbed a phone and mentally rehearsed what I would say as the dull staccato chord of the outgoing ringtone echoed in my ear. No answer. I knew from reading your chart that your mother used to accompany you to dialysis, until you two were separated in the clinic for arguing during treatments. That was 10 years ago. Was she still alive? If she was, would she want to come? I didn’t know the answer to those questions, but even if I did, I didn’t know how to reach her.

I wondered if you were scared, if you knew you were alone and wanted someone there. It seemed wrong for you to go through this alone. As the rest of the code team whirred around me feeling for pulses, monitoring the rhythm on telemetry, preparing drugs to be injected, I reached for your hand and held it in mine. Your skin was a deep brown, your palms with crisscrossing furrows etched across them. Was your tanned skin the result of days lounging by the pool, or the byproduct of long hours of manual labor in the afternoon sun? Your fingers were unadorned: no wedding ring, no watch. Traces of dirt lingered under your fingernails. Your hand felt cold and leathery; I could feel the coarseness of your fingertips and the callouses on your palms as I gently stroked your fingers. “It’s okay, I’m here,” I whispered, partly to you and partly to myself. I don’t know if you felt me there—probably not, as you were unresponsive at that point—but I’d like to think you sensed my presence, even if you weren’t able to respond.

We had you hooked up to machines, injected with all kinds of drugs, surrounded by all types of specialists. Is that what you would have wanted? We never did get a chance to ask you. You were a bit disoriented when you first came to us, and we figured we could talk to you more about it later. But things hadn’t gone exactly as planned—at least, not how we, as medical professionals, had envisioned it. Did you know, when you first came to the hospital, that things might end like this? And if you did, were you at peace with it? Were you ready to go?

As I watched the team come to the realization that further intervention would be futile, I tried to put myself in your position. What would I want this day to look like if our roles were reversed? Would I want someone there with me, or would I rather spare my family and friends the pain of watching me die? Would I answer these questions differently at the end of my career, after seeing my 20th code, as opposed to after seeing my first?

I don’t know you—not really, anyway—and you will never know me. And I still don’t know the answers to the questions I asked of you, of myself, and of my colleagues that day. But because of you, at least I’ve started to ask them. And for that I am forever grateful.