I am awakened by the loud, screeching sound of my pager. I feel my heart race. I look at the clock.
It is 3:07 a.m. It’s cold in the room. I am shivering. I stand up quickly, instinctively. I feel the soreness of my feet for a brief moment, but push that thought aside and look quickly at my pager. It reads, “room 2309, death pronouncement”.
My heart sinks. She is mine—my patient. I have been taking care of her tirelessly for the past six days. Transfusions, infusions, procedures after procedures, blood draws, medication changes all come to a rapid halt now. I know she is DNR (do not resuscitate).
Liver cancer. 49 years old.
My body is tired. My eyes ache. My back and neck have a nagging soreness. There is a heaviness in my chest, a sadness in my heart. I put my shoes on and run quickly up to the floor.
I enter the dark room. The light is dim, and there is an eeriness all around. No sound is heard. I slowly approach her bedside. I put my fingers on her carotid pulse. No pulse. Her body feels warm still. I gently lift her eyelids and shine a light into her eyes, noting the bright neon yellow discoloration. The image of her eyes leaves a stark imprint on my mind, but I push the thought aside quickly. I move my gaze to her chest. Her chest is still. No movement is seen. No breath sounds are heard. Heart sounds are absent. Almost instinctively, I take a deep breath myself. Time of death 3:11 a.m.
I have been up since 5 a.m. the previous day. My feet are heavy, swollen, and achy from standing all day long, tirelessly running from room to room, examining patient after patient, taking history after history. I feel a burning in my stomach from lack of food and a dryness in my mouth from lack of water. I come back to my room for a brief moment to take a breath. I notice some sort of an insect on the old shower floor adjacent to my room, but my mind goes back to the patient. Her haunting yellow eyes and lifeless, cold hands cannot leave my mind.
I let it go just for a moment and let myself feel the grief. I must feel the grief. I must feel the pain, for I know, that if I fail to allow myself feel this, it will be difficult for me to be fully present with my next patient, with my friends and my family. My very humanity and soul depends on it, so I let myself feel. I know too well that numbing my feelings will silence my spirit, so I let myself feel. I take another deep breath.
A warm feeling rises in my heart, and a lightness of being follows. “It will be ok. It is going to be ok,” I mutter to myself in my dark room. I whisper a prayer for my patient. We did everything we could. We did. My thoughts quickly rush to her young daughters, one of them in college. After a brief pause, I return to the floor to take the next step. I must call and notify the family.
3:23 a.m. I pick up the receiver. I dial the older daughter’s phone number. “This is Dr. Tatosyan. I am so sorry to awake you at this hour, dear, but I have to tell you …”
Breaking news like this is hard. Breaking news like this in the deep darkness of the early morning hours is even harder. I feel guilty for having to wake her up so early with this terrible news, but I have a duty to tell.
Tears running down my face, I notice the look of a passer-by and wipe them quickly away. “I am so sorry. I am here for you. Please take your time when you come in. You can stay as long as you need in the room. I am so sorry”.
Our job is heartbreaking at times—many of the times. We physicians endure endless, grueling hours of training in medical school, residency, and beyond. This job cannot be done without “one’s heart in the right place.” We sacrifice our youth, our health, our sleep, our personal lives, our families, and ourselves because we are called to be Physicians. No money, no title, no prestige could ever come even close to be enough of a motivator for any of us to do this, because it requires our humanity, compassion, heart, mind, and spirit to do this job and to do it well.
This job is about love. This job is about sacrifice. It is about choosing a calling to heal and helping others at the expense of our time, our youth, our health, and our life.
This job is imparting love to another human being. I remember in medical school and residency, as I would stay up long hours into the dark night studying and learning and working, what would keep me awake and motivated me to keep going was knowing that one day, my decisions would make the difference between life and death for someone. I knew that the quality of my training would affect another human being, and I had a responsibility to give it my all.
It takes compassion and selflessness to do that. To bear the suffering and burdens of patients on a daily basis not only takes compassion, but it takes an enormous heart, a gentle, kind heart, and a spirit full of love and devotion. That’s what a heart of a physician looks like. We are givers. We give our time. We give our heart and soul to our patients. We use our hands and minds and hearts to heal, to comfort, to relieve suffering, to guide, to teach, to inspire, and to give hope to another human being.
That is who we are and who we have always been. The electronic advancements may have made it appear that we stare more at our screens than into the eyes of our patients, but please make no mistake, that when we are staring at the screens, we are doing our best to gather, interpret and understand information that can make a difference between health and illness, relief and suffering, life and death.
This is who we are, and this is why we are here.
Kristine Tatosyan-Jones is a family physician.
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