For what seemed like an hour, I stood staring at the flat lines scrolling endlessly across my monitor in the OR. The once pulsatile waves, rendered useless and flat due to the absence of a beating heart. After a frenzied six hours of pouring blood into the patient while it poured back out of her just as fast, the surgeons drowning in blood in their attempt to sew the new liver into place in hope that this vital organ would begin producing the necessary clotting factors to stagnate the hemorrhage, the patient coded and despite multiple rounds of ACLS, we finally called time of death.
The OR was now still, the life-sustaining efforts fruitless. After a while, I reached up and turned off the monitor to end the relentless alarms warning me something was amiss with the patient’s vital signs. In all honestly, I think I wasn’t sure how I was supposed to just leave the OR, without my patient. Anesthesiologists are trained to roll their patients into the OR and back out again. We are the last person to leave the OR, with the patient. Always with the patient, not leaving their side until they are stable and full report has been given to the nurse taking over care in the PACU. As I turned to walk out of the room, I was forced to step over a literal pile of plastic blood product bags, tossed on the floor haplessly in my resident and tech’s rush to hang more.
I walked out of the OR, around the corner to the OR desk, to the reproachful eyes of many of my colleagues. At this point, the tears finally started. A friend and mentor took me into the Anesthesia office and allowed me to both cry and compose myself, offering a hug, if it weren’t for my blood-splattered scrub top. She reassured me that I had done nothing wrong, had done everything within my power to save that patient. That she was sick; the riskiest of the high risk. I am not sure anymore if the tears were from frustration, shame, or exhaustion; probably a combination of all three.
At this very moment, my imposter syndrome was rearing its ugly head, had me questioning if I had done the right things, given the right medications, infused blood quickly enough, if a different anesthesiologist would have been able to save the patient. No, I knew this wasn’t true. Three attending anesthesiologists were in the room at one point as well as three attending surgeons, all fighting this losing battle together. She was just too sick, for too long. Oddly I’d had a premonition about her death when I’d spoken to her pre-op; she had a young daughter, the same age as my second and I remember thinking, “It’s so sad that this little girl is going to grow up without her mother.”
After composing myself, I changed out of my bloody scrubs and slowly walked the long walk to my office to relieve my engorged breasts of milk, my own baby’s needs ignored for hours on end while I fought to save this patient’s life. After pumping and letting the milk and emotion drain out of me, I took to the task of charting what had happened over the past few hours. The EMR had pulled in all of the vital signs and a CRNA, who had been called in just to chart, had at least documented the administration of medications and blood products in real-time. But a narrative of the events still needed to be put into the document, as the EMR is not able to describe what had happened, the quick thinking, the teamwork, the communication, the last-ditch attempts to save the patient. An hour and a half later, I changed again, into street clothes and shoes and drove home in silence, going over and over the case in my head. What could I have done differently, maybe we shouldn’t have done the case; but she would have died if we hadn’t. Toward the end of the drive, I transitioned my brain to home mode. Wife and mom mode.
When I walked in the door, I told my husband that I’d had a bad day. A really bad day. The worst of the worst. I talked to him for a bit, then I went into my baby’s room and picked up his warm, perfect little body and just sat with him. Let myself enjoy him, tried not to think about the little girl who would grow up without her mom. I pushed these thoughts out of my head, instead focusing on the perfect smell of my baby.
My medical training had prepared me for a lot of things, but this was not one of them. When you deal with people, real people who have lives and stories and emotions and families, all day, every day, these stories stay with you. Doctors get a bad rap for not caring, for not spending enough time or emotion, but the truth of the matter is that we often care too much. The people I take to the OR are someone’s mom, sister, uncle, son, grandmother. I care for each one just as I’d want my own taken care of. And when something goes amiss, I take that with me for the rest of my life. I learn from it, I question it, I go over it in my head, trying to figure out how to prevent it from happening again. But we also have to learn to move on, to apply what we learned to help someone else, to push it out of our heads so that we aren’t paralyzed from being mom, wife, aunt, sister to our own families and doctor to the next patient we have to go on and see.
I once told my husband, who works in the tech industry, “You have a bad day, something doesn’t get done, I have a bad day, someone dies.” I encourage everyone to remember this the next time they think doctors are paid too much or don’t care enough. Bad days are high stakes in this job, and after a bad day, we take a deep breath, adjust our hats, and go back and do it all over again.
Sarah Reck is an anesthesiologist who blogs at All The Moving Pieces.
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