First Timers

Names have been changed in order to protect the personal privacy of patients and families.

I never had the chance to introduce myself to Ms. Jones. She was without a pulse the night she was wheeled into our emergency room by EMS personnel after arresting during dinner with her family. I, a newly-minted medical student, was in the midst of seeing another patient when a monotonic voice over the intercom abruptly interrupted our meeting to announce her pending arrival: “ROSC en route, t-minus five minutes.” I left the room to join the rest of the team organizing in the resuscitation bay, confirming their roles in the resuscitation around the gurney and casually going over their plans for the weekend.

Paramedics swung the ambulance bay doors open and the airs of the room turned. They immediately began giving us the story: “91-year-old woman... witnessed loss-of-consciousness observed by family at dinner; thought we got a pulse in the field, resuscitations been going 10 minutes.”

“God help her, she’s nothing but skin and bones,” I thought to myself as the rolled past, one paramedic on top of the gurney rhythmically administering CPR. The frail old woman remained still and closed-eyed while as our team took over chest compressions and put an access line through her shin. A breathing tube was inserted. “Rob, you’re up next for compressions,” my attending calmly said to me after the first two minutes.

There is something quietly unsettling about the ‘firsts’ for medical professionals in training, an inescapable reality that is apt to shatter the confidence of provider and patient alike. From a first time intubating to informing family members of a failure to resuscitate, medical students and residents in the ER are given first glimpses into new procedures, conversations, diseases, and, of course, people with vulnerabilities every day. It’s not only a necessary part of being a doctor, but also of being a patient. This would be my first time performing CPR on a person, and I felt equivocally horrified and excited.

I took over and instantly realized why nine-out-of-ten doctors prefer not to be resuscitated in the event of terminal illness (1). Her ribs cracked like eggshells under my palms with each push. Eventually the eerie intermittent silence in the room was punctuated only by a low-pitched grunting sound of air being forced from her lungs and calls to pause after every two minutes to recheck her pulse. Her still, exposed body would nearly slide off the gurney with every other push, requiring constant repositioning by nursing while others intermittently pumped air through a breathing tube.

Ms. Jones would be pronounced dead a few minutes after a final call for any other suggestions, though truly died well before then. The team exited the bay and her limp body was left sprawled on the bed to be cleaned before her family came in to see her. “Good job up there, kid, there wasn’t much we were going to do,” my attending told me afterward, my hands still shaking from the adrenaline. “This was the same circumstance of my first time doing CPR thirty years ago,” he said, “a long-shot revival, but good practice anyway.”

A year later I’d have my first formal BLS training, training extensively with mannequins on proper compression depth, rate, and bag mask ventilations. Nothing, however, can replace or prepare you for the weight of a human life beneath a pair of interwoven hands.

References
1. Gallo, J.J., Straton, J.B., Klag, M.J., Meoni, L.A., Sulmasy, D.P., Wang, N., & Ford, D.E. (2003). Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others? Journal of the American Geriatrics Society,51(7), 961-969. doi:10.1046/j.1365-2389.2003.51309.x

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Rob

Med student and aspiring ER doc. Hobbies: Climbing on rocks aka rock climbing