The sad thing is, I hardly remember the patient. Everything about her is just an overhead pediatric trauma alert followed by the flurry of cutting clothes off, throwing IV lines, and calling out our primary and secondary survey — “blown right pupil,” “unequal breath sounds,” “gross deformity to left ankle,” and then, “no pulses” — followed by the age-old barbaric resuscitation efforts that are now muscle memory to us, as we compressed her sternum still with bits of her Forever 21 bra on it and shoved a MAC blade past her pink braces.
When you lose a patient — and every ER doctor has — you take a breath and pick up with the cornucopia of ailments that have filled the beds in the meantime, from stubbed toe to stroke alert. Shell-shock doesn’t have an opportunity to sink in until after you sign out. You grab your backpack full of snacks you never had time to eat and emerge from the hospital, not recognizing fatigue, hunger or your own distended bladder, the cool morning air assaulting your face the only thing reminding you that your own heart is still beating.
From the start of medical school, you are trained to be immune to it — hazing is anatomy lab, where your stomach starts to toughen when you take your first cut into the trapezius. Still it churns the day you turn your cadaver over and see his/her face for the first time. My medical school held a vigil for the families of donor bodies — and while it is a step to understanding the meaning of the donation, there is a gravity to it that would be debilitating to feel every day in the dungeons of anatomy lab. So you come up with compensatory mechanisms: comparing the gastrocnemius dissection to the turkey leg you are ravenous for after four hours in anatomy lab, gossiping about newest class couples while flecks of adipose tissue fly past your face, and yes, names for the cadavers — from normal ones like “Bob” to ones that just help you dehumanize like “Juicy Lucy.”
From that point on, you’re now inoculated to the medical profession — a profession that saves lives but that often silences death. The “dealing” is up to you — you’ll find your own way to “deal” with your first death on the ICU. You’ll get through accepting the strangeness of taking scalpels to breathing bodies during surgery.
And notably, you’ll come up with ways to tolerate — from remembering “Juicy Lucy” and her carpal bones during orthopedic clinic, to being blasé about death, to perhaps most commonly, morbid humor and disengagement. Whatever it is, we all do it to some degree and fashion. The irony in a career of caring for people is that to do it effectively, you sometimes have to stop caring about the actual person.
It is strange the things that stick with you. In the case of my pediatric trauma, like I said, I hardly remember her face. But what I do remember is the scream of her mother when she was called in to identify the body. In every sense of the word, it was a sound that made your toes curl, that embodied raw, untamed, unbridled pain; the exact frequency of the cry of a dying animal in the wild. It made my soul cringe when I heard it, and it probably had the same effect on everyone else in the department — it did not take long for two large burly security men to rush in and carry the mother out, her body collapsed and defeated, but her mouth still screaming. After particularly tough shifts, I sometimes have a ringing in my ears that same frequency of her screaming “my baby, my baby” as she wept over her child’s body.
For some, the picture of the ER physician on Reddit embodies pain. For myself, it’s that scream. No matter what it is, every physician has a trigger that takes them back to that feeling that we all have experienced. While we all have ways to cope, sometimes taking a step back and letting the feeling overwhelm you for a few moments is healthy. It is healthy to feel, and to feel deeply, because that’s the nature of what we do. What we do has deep implications for our patients, their families, our staff and ourselves. We are all human, and it’s OK — nay, necessary — to act that way sometimes.
Amy Ho is a resident physician.