Gone.
A very young Meris, working on the medic
I want to tell you a story.
Today I saw a post about things they don’t teach you in nursing school, and having gone through other forms of medical education, I can safely say that one of the things they don’t—or can’t, really—prepare you for is experiencing the death of a patient. There’s just not a way to be prepared, but the overwhelming odds are that you’ll experience it. Probably multiple times.
In my years working in emergency medicine, I’ve experienced the deaths of dozens of patients. Sudden deaths. Violent deaths. Unexpected deaths. Expected-but-still-painful deaths. Peaceful deaths. Deaths that left me with flashbacks, nightmares, five-figure therapy bills, and a medicine cabinet of store-bought neurotransmitters.
But there’s one that stands out above the rest. The first.
I want to tell you about a young man for whom I cared when I worked in the emergency room. A young man who died under my hands, and whose face and name I can still remember.
The emergency room always feels like a liminal space at 11pm. Outside, the birds have stopped singing and only the insects chirr in the heat of the summer. The fluorescent lights of the ER stand in stark contrast against the cloudless inky blue of the night sky. Inside, it’s cold and crisp, buzzing with activity. There’s an electric hum you can just barely make out, and you’re never quite sure if it’s coming from inside your own body or not, or if everyone else can hear it as well.
My pager went off, doing the “incoming trauma” dance as it vibrated across the desk. So far, most of the trauma alerts had been benign. A stabbing here, a car crash there, but nothing too intense. As I headed towards the trauma bay I could hear the medic calling in report. Twenty-one year old male, gunshot wound to the leg. Lots of bleeding. It had been minutes since he was shot before anyone called 911. Things didn’t look good. His vitals were trash and you could hear the panic in the medic’s voice.
When he arrived, you could sense the change in the atmosphere. There was nothing but action. Doctors calling out orders. Nurses calling out meds as they pushed them. And 18-year-old me, in the midst of it all, starting a second line.
He had made eye contact with me as I started his line. He grabbed me by the collar of my scrubs.
“Help,” he whispered.
I grabbed his hand after securing his line. “We’re here to help,” I had assured him. "
“Help me.”
A pleading in his eyes.
“Help.”
I squeezed his hand.
A momentary, eerie quiet. The needle skipping on the record of linear time.
“Okay, he’s in asystole, start compressions please.”
I felt myself get shoved out of the way as a nurse started CPR. I got in a long line, ready to take over compressions. I knew he’d be okay. He was in the hospital. He was young. He was healthy. He’d be fine.
The nurse quickly tired and was replaced. I moved forward in the line. I stared straight ahead, afraid to move. Little by little, I inched forward, realizing I would soon be at bat. Somehow time moved so slowly but in warp speed all at once. I felt dizzy. Had I been holding my breath this whole time?
“You’re up,” the nurse said as he stepped away.
I did what I was trained to do. I pumped his blood for him. I accidentally caught his empty gaze and felt a sob catch in my throat.
We went through another round of the CPR volunteers and before I could believe it, it was my turn again.
I purposefully avoided his gaze this time. I turned my head away from him. His clothes had been cut off and all I could see were his boxer shorts, covered in a teddy bear pattern.
Teddy bears.
He was still so young.
“Stop compressions.”
He died under my hands, right there on the table.
“Stop, stop,” the doctor had said to me softly, turning off the monitor.
“But, I…”
“Just stop, Meris, it’s okay. He’s gone.”
Twenty-one years old, with his whole life ahead of him, and he died.
Alive, shot, dead.
Shot in the femur. Dead. Gone.
My compressions did nothing but circulate stale blood through tired veins.
Gone.
“Time of death, 2313. Good job, everyone.”
I remember his arm hanging, useless, to his side. Hitting me in the leg during CPR is its final act. I picked it up gently in my hands and put it on top of his stomach.
Gone.
His pleading eyes and barely audible whisper of “help” haunted me for years. No one prepared me for it. Not one told me what you’re supposed to do after a patient dies. Not in the “facility policy” sort of way, but in the…”after you go home and are expected to continue living your life” kind of way.
So I figured it out on my own. I did really unhealthy things like buying a king-sized bag of twizzlers and a 2-liter of coke and putting it all in my face as quickly as possible. Or driving aimlessly in a time before GPS devices were readily available and having to spend hours finding my way back home. Or sitting on the floor of my shower until the water turned cold. Or lying motionless in bed during my off-days, moving only enough to avoid a pressure injury.
No one told me what you’re supposed to do when you go home.
I’ve developed much healthier coping mechanisms now, and I have an incredible therapist who’s skilled in treating patients with PTSD.
What works for me won’t necessarily work for you, but my advice is this:
Ask what the CISD or other psychological resources your facility has available to its employees and how to request those services before you ever need the help. Don’t try and navigate this when you’re traumatized.
And then use those services when you need them!
Get a therapist. I think everyone should be in therapy always, but I genuinely do think you should be a patient of a mental health expert. Even if you only go a few times a year for a “tune up,” it’s a LOT easier to make an appointment with a provider when you’re already a patient than to try and become a new patient during a time of stress.
Do something to get it out. Keep a journal. Write about it. Draw what you feel. Make music. Work on a knitting or crochet project you only tackle when you feel overwhelmed. Get into nature. Do something to help you feel grounded and like you’ve let the emotions see some of the light of day.
Be kind with yourself. It’s okay if you feel devastated but you think your coworkers are all just…fine. It’s okay if you just need to take a day to binge cooking shows and order Door Dash. It’s okay if you need to take some PTO. It’s okay. Do what you need to do.
Do your best to avoid unhealthy coping mechanisms. Ask for help if you feel stuck in a maladaptive way of managing your stress.
Have you experienced the death of a patient? What would you suggest for someone experiencing it for the first time? Let me know.
Don’t forget to take your meds, and stay hydrated.