After a drowning: An impossible question a doctor faces

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I head to work at my new locums job on the California coast. Summer 2015 is going to be a great one, I think to myself. I make the turn into the hospital parking lot, and a rusty old Trans Am cuts me off. I slam on the brakes to the soundtrack of screeching tires. Geez, I think to myself. It’s my first day at this job, and they’re already trying to kill me. I drive on, and I pull into my parking space. My headache is starting a little too early for this shift, I think to myself. The sun is out, the sand is hot, and it seems like everyone must be at the beach but me.  The humid heat is as thick and soothing as suntan oil.  I leave it and walk into the cold and clinical hospital.

Out of the EMS radio and through the air crackles, “Elderly female cardiac arrest … drowning … intubated … no pulse … 45 minute down time … eta 5 minutes.”

Jane the nurse looks at me.  “This one’s yours,” she says with a wink.

“You got it,” I answer. Way to start off with tragic one, I think to myself and take a deep breath, shaking my head.

“Boom” goes the grinding, mechanical sound of the automatic doors as EMS rolls the stretcher into my ER. In they wheel my patient, while feverishly sweating and performing CPR and bagging air in and out of the patient, one breath at a time. With my back against the wall, they wheel the head of the bed up to me. I see a large, elderly female, dressed in a bright orange one-piece women’s bathing suit. I grab my laryngoscope and look to make sure the ET tube is in the airway. Her face is bloated and purplish-pale except for the mess of pink lipstick smeared around her mouth, likely from EMS attempts at placing the tube. I check the tube, and it’s OK.

“45 minutes with no pulse at any time? Drowning?” I ask EMS.

“Yes sir,” responds one of the burly EMS guys. “We got the tube in right away, started CPR, gave epi per protocol, and … nothing.”

“Did you see any of her family?” I ask.

“No family. She was with a big church group at the beach for a picnic, with a bunch of kids. Youth group, or something,” says the EMT.

“What? Doc. Look!” says Nurse Jane, who had just cut off the patient’s bathing suit, pointing at the patient’s groin.

There, no longer covered by the woman’s bathing suit, is a penis and testicles. I look at Jane, I look at the two EMTs, and they look at me.

“I’m just as confused as you doc,” says the EMT, looking at me wide eyed as he raises his hands.

“What’s the patient’s name again?” I ask. “Let’s make sure we have the correct patient and correct name.”

“We’ve got a driver’s license and the picture matches. Pat –, female, is what’s on the ID,” says the EMT.

“So, the friends that are here, know, or don’t know? Help me out here.”

“I have no idea, doc. Her friend, who looked like a little old church lady, referred to her as ‘she.’ That all I know,” answers the EMT.

“OK, thanks. Regardless, we have no pulse, over 45 minutes of downtime and zero chance of survival with a warm water drowning. Time for me to call the code and notify the family. Time of death 17:01.” CPR stops. I’ve declared the patient is officially dead.

The headache I had on the way into work is now much worse. I need a coffee and some ibuprofen. No such luck. The waiting room has been filling up frantically in the past few minutes with many new patients to be seen. I need to go tell this patient’s friend she’s dead. I walk out to the consultation room and open the door. On the floor kneeling is an elderly woman, with big white hair, praying, crying, reciting Bible verses. She stands up and faces me.

“Hi, I’m Doctor Bird. Are you with Pat –?” I ask her.

“Yes, please tell me she’s alive. God help me,” she pleads and sobs.

“I’m sorry. She’s dead,” I tell her, my throat aching and my voice cracking a little bit. She slumps towards me, almost falling and I have to hold her up.

“I’m sorry,” I say. “We did everything we could, as did EMS. What happened?” I ask.

“We were at the beach with the Church children’s group. Pat was dearly loved by those children. She lived for them,” she sobs, wiping tears. “She was the most blessed person I ever met. You know, the Bible says we’re all sinners. But if there’s one person in my life I’d have to say I don’t know to have ever committed a sin, it would be her. She truly was a servant of God and a wonderful person. That’s why I can’t understand why she did this.” She sobs again.

“Did what?”

“We were there on the beach. Pat, the children, the other ladies and I. Pat gave each and every one of the children a hug. She turned to us and said, ‘It’s time for me to go back to God so he can fix me, for my whole life is a sin. Goodbye.’ We all looked at her confused, and before I knew it, she was walking towards the water. Pat did not know how to swim. She calmly walked into the water, all the way up to her chin, and then disappeared. We all started screaming; we called the lifeguard, and …” She sobs. “And then she was gone.”

“Wow.”

“Can I see her?” she asks.

“Yes you can,” I say, as I walk with her towards the resuscitation room.

I open the door, we walk in the patient room, and in the room is Nurse Jane, having just covered the patient up with a white sheet, everything but the face.

“Can I see her?” asks Pat’s friend.

“Yes, of course,” I say and gesture with my hand, towards the body.

“No, I mean, can I see her?” she asks.

“Yes, of course. That’s her,” I say, a little confused as to why she asked twice.

She walks up to the gurney. She puts her hand on Pat’s face and cries a little bit, muttering what sounds like a prayer, but very quiet. She puts her hand near the neck and grabs the white sheet. Slowly, she starts peeling back the sheet exposing Pat, until the body is fully exposed. She stands there, now stoic and expressionless, looking at Pat’s naked body.

“It all makes sense now.” After a long pause with a blank stare, she says,  “Doctor.  Can I ask you a question?”

“Of course,” I say.

“Doctor,” she says.  “And I need you to answer.  I need you to answer.  Does God still bless her soul?”

“BirdStrike” is an emergency physician who blogs at Dr. Whitecoat.

Image credit: Shutterstock.com

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