Crash Course

Recently, on my internal medicine rotation, a code blue was called in the emergency department before a patient on our service could be fully admitted. We ran down the stairs, full of adrenaline, and ran into the room starting chest compressions, running through ACLS algorithms. During chest compressions, I had flashbacks to my time when I was a Forensic Autopsy Technician. I remember the autopsies of patients who sustained broken ribs and bruises while undergoing these life-saving procedures. Unfortunately, similarly to those of before, the patient could not be brought back.

The room became silent, what was previously beeping alarms, buzzing communication between team members, a leader shouting orders. It was now quiet enough to hear a pin drop. The room emptied quickly as the daughter was brought in to see her mother. The nurses cleaned and covered the body. The daughter remained alone, in shock. Likewise, I was in shock. Though being surrounded by death in my prior career field, I had never seen life pass from a patient while actively fighting against it.

But I had seen this before, I recognized the look of utter devastation on the daughter’s face. I had been in this situation before. I was ready.

Falling back on my prior lesson in the morgue, I placed a hand on her shoulder and made my presence known. A subtle suggestion: she was not alone in this. Even if we did not know each other, she was supported. We shared the quiet moment as she took the hand of her recently deceased mother in her hand and wept. No words were exchanged for several minutes as the shock wore off and I left her in the care of other family members who were just arriving. Again, work proceeded as normal. The physicians had become accustomed to this, but the shock of the situation still permeated throughout my thoughts during the day. Images of her mother’s face during chest compressions, the sounds in the room followed by a hallowed silence that seemed to infiltrate the entire emergency department. My second crash course, beyond grief, a lesson in resilience. Emotional fortitude. Suppressing feelings throughout the day so that mistakes for other patients would not be made and other patient lives not affected. Accepting that my time to acknowledge these emotions would have to wait.

Doctoring courses are amazing for actions to take and ways to console patients, but it is far different from the actual situation where emotions are raw. I feel as though no amount of preparation will prepare students for their first crash course. When they’re not expecting to learn, when they’re not ready to be confronted by an emotionally challenging situation, where the most learning is done. It encourages one to grow most as a person and develop fortitude. A critical skill that as a potential future emergency physicians we can expect to utilize and hone throughout our careers. A skill that allows one to sit and be with someone in a crisis rather than letting them wade through grief alone. We’re all humans, and we all need support.

To this day, I continue to think about the family from the morgue, about the patients at the oncology clinic, and about the daughter who had just lost her mother. I wasn’t ready to experience any of these situations, and they are now forever a part of my being. Each encounter developing my emotional fortitude and ability to console. I am eternally grateful to these fantastic people. Without them, I would not have learned to separate myself from the turmoil of a situation and provide support to those family members who may need it most. They will be lived on through all my future patient interactions as they have prepared me in ways that no medical class could.

Share your own Crash Course story in the comment section.

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 Jon’s Bio is below. Keep scrolling down.

Jon Warren

Third year medical student soon to be Emergency Medicine resident. Photographer. Hiker. WikEM editor. Netflix watcher. Dog enthusiast.