Going through the motions
When detachment is necessary...
Going through the motions starts with a little boy on a stretcher. Paramedics rush to deliver his lifeless body. Nurses and techs descend upon him like a swarm and the only things you can see of the boy are his wet hair, white lips and dull grey eyes. The medics say something about a pool party…floating face down…thirty minutes of CPR. There’s panic in the room but you remain calm - the kind of calm that falls upon a physician who knows that it’s too late. You’re reminded that the only thing more quiet than a soul leaving a body is a child sneaking into a pool.
You go through the motions and feel his neck for a pulse that isn’t there. You insert a metal blade in his mouth, to clear the tongue and tender flesh in the back of the throat. You advance a breathing tube past the vocal cords and slide it into his lungs. Each breath lies in your hand. You watch the flat line on the monitor and the shock paddles sitting idle in its holster. A dead heart cannot be coerced, but you deliver a milligram of epinephrine anyway. You commend the young EMT for doing good chest compressions. Rivulets of sweat bead down his neck forming dark circles around his collar.
Someone ushers in the boy’s parents. They hang on to each other as though one depended on the other for survival. You try not to look at them because it’s too much like looking in a mirror. You distract yourself by going through the motions: check for a pulse…breathe, more epinephrine…breathe, chest compressions…breathe. You won’t have to face the end if you keep going.
The nurses look to you for mercy. The courage arrives when his parents’ eyes land on the cold linoleum floor. You go through the motions of shining a light in the pupils and interrogating the heart when the answer is already known. You declare his time of death. You tell his parents - I’m sorry. I wish there was more we could do. The mother trembles in her husband’s arms like a pine needle in a storm. A primal scream escapes her that will haunt you. You walk past her, when all you want to do is run.
The father’s voice grabs you from behind - Doctor. You don’t want to turn around to face the slumped shoulders and red puffy eyes. You don’t want to hear the words when he says - thank you…for doing everything you could for my son.
You say - I’m very sorry for your loss. You fight the impulse to hug him because you don’t want to think of your child lying on that stretcher.
You walk away and attend to the man in bed 7 with chest pain, the geriatric in bed 12 with weakness, the child in bed 2 with fever, and the 20 other patients in the waiting room without beds.
Going through the motions is no way to live. But it’s what you do to survive.
Jay, this is a beautifully rendered portrait, and yet I can't walk by. What would have happened if you had hugged that father? If you had stood with them and shared the pain? I've been here, and I know what the "code" is (and I don't mean the code blue, I mean the behavioural, the professional code), but it's killing us! What would have to happen to make the connection and to metabolise the grief, the tragedy? I think we've got it wrong, and the hidden curriculum just jacks us up, lacks imagination, overrates objectivity and distance as the only real survival strategies we pass along as ways to maintain presence of mind in a crisis. I truly believe it's possible to broaden our repertoire so that we can navigate these fraught situations and come through feeling more vital, less cut off. Now I have to read more of your posts . . . but I'm pulling for the hug, for leaning into one another when we're shattered. Thank you for bringing this story.