Girl, interrupted

I have spent literally hundred of hours with cadavers – either as a students in the anatomy lab or dissecting them for those students. I’m comfortable with cadavers. Really, they don’t bother me.

But this week working in the ED I had an experience that unexpectedly shook me.

It was a fairly busy night like any other; I was working as the EKG tech – running from room to room getting 12-Leads on the usual mix of chest paineurs and overdoses. With a break in the incessant buzz of my pager, I sat down at my computer behind the nurse’s station to enter orders and do assorted paperwork. I barely noticed the Vocera announcement that a trauma one was coming in. I’m not a regular ED tech, and I’m not signed off to work on a trauma team, so it’s only something I notice in passing.

My computer is next to the telemetry screens so that when I’m doing paperwork I can monitor what’s going on in the ED. Halfway through entering an ordering a red flash and a chime caught my eye — ***VTAC***. It was in a trauma bay.

In that moment I became aware of the huddle of nurses and techs behind me. Apparently the trauma one had become a traumatic code en route to us. Not good. We watched holding our breath as the rhythms bounced through various iterations of ACLS badness. My pager went off and I was torn away to do more 12-Leads.

I passed the trauma bay a few minutes later in the course of my normal duties. CPR was in progress. I casually noted that the compressions were probably a bit faster than the AHA guidelines of 100 per minute and wondered if there was any data to suggest that there were better or worse outcomes for faster compressions. I didn’t think much about the code; I was a good three pages behind.

Later I sat down at my work station to do more paperwork. I looked at the trauma bay on telemetry: ***LEADS DISCONNECTED***

That’s either really good or really bad. Statistically I knew what do expect.

At that moment I overheard one of the nurses mention that they had called it just a few minutes before and were preparing the body for viewing by the family. My heart sunk.

Even though I knew that she was basically dead before she hit the ED doors, even though I wasn’t on the trauma team that worked to save her, I felt culpable. It felt so wrong, knowing someone’s daughter had died before her parents did. I honestly felt a little sick.

The familiar nagging of my pager brought me back into focus. Off to do another 12-Lead…

It wasn’t long before I needed to cross the hallway by the trauma bay again. As I approached it somehow seemed longer..emptier… lonelier than I remembered. As I got closer I recognised one our social workers standing outside with her back to the bay and her head hung low. I could make out muffled whimpers and cries from the inside. My heart sank again. I took a detour through the imaging department to avoid walking past. It seemed like the right thing to do…this was a very private moment for someone else. I went about my business for the remainder of the shift, avoiding the trauma bay like a crack in the sidewalk or the path of a black cat.

Toward the end of the shift I had some chores to do – namely refilling the blanket and fluid warmers. This includes the trauma bays. I did every other part of the ED first. Then I did all the other trauma bays, hoping that I would run out of clean blankets before I got to where she was so I wouldn’t have to see her…no, so I wouldn’t have to disturb her. I swore in my head a little when I still had blankets as my cart squeaked up to the threshold outside her room. I carefully and quietly peered in to make sure no family were present. It had been hours, but who knows.

She was on the table, laying there peacefully with her arms unnaturally still at her sides. The ETT tube was still in place. Her face and hands were ashen. The room was dark except for a single light above the table that illuminated her white draped form. Two empty chairs from the lobby flanked the table. I quietly slid in to refill the blanket and fluid warmers. The hair on the back of my neck was standing on end. My heart was racing. My mind was going even faster, calculating all the reasons that this shouldn’t be happening. Every ounce of my being cried out “this thing should not be.” I realised that what I’d felt earlier was not sickness, but sadness.

I apologised for disturbing her, and not just in my head. You might think it’s weird, but if you’ve spent any significant amount of time working in a cadaver lab, you’ve likely started talking to them. It’s probably more to put me at ease, but I like to think they can hear me. Well not the physical-them that I’m working with, but the spirit-them that’s now out there somewhere.

I finished my task and took one long last look at her before my pager went off again. Someone had ordered another EKG on the panic attack.

This experience genuinely spooked me. When I got home I needed my fiance to come over just so I could hold her tight and tell her I loved her. I needed to know she was okay. It took every ounce of self control not to call her and make sure she was okay the second I’d head that the code was called.

But, why did it bother me so much in the first place? Like I said I’ve spent hundreds of hours with dozens of different cadavers. What made this so different? I’ve narrowed it down to a few things.

1 – She was young. Younger than me. And that’s just against the natural order of things.

2 – While most don’t choose death, at least cadavers in a lab have chosen to be there. A certain serenity comes from knowing that everyone is there because they want to be. That wasn’t the case here.

3 – I’m used to working on a cadaver, and then learning about who they were as a person by reverse engineering their medical history and listening to family members at memorial services. To me, cadavers become people. I’ve never had to mentally transition the other way from person to cadaver.

I hope in some small way that writing this out will be therapeutic and help me organise my feelings. I know this is just the first of many of these experiences that I’ll have in emergency medicine. It has to be a valuable lesson – of what I’m not sure yet.

I just hope that when I close my eyes to go to sleep tonight, that I can stop seeing her face.

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