Saturday night was not a good night at work.  It wasn’t a particularly busy night full of consults and pages with questions (yes, doctors still use pagers).  But in the ICU, there was a young man struggling to survive.  And in the middle of the night, his struggle ended after 45 minutes of CPR and ACLS resuscitation.

I’ve been to many a code blue in my career thus far, short though it may be.  This code didn’t feel any different to me than any other.  The patient had adequate IV access, so my surgical capabilities weren’t needed, but I stayed around to help with chest compressions and offer support for the other doctor as well as the nurses and techs who were in the room.  Nothing struck me as unusual about this code… until the patient’s parents showed up, at which point, the code became traumatic for me as well.  There’s something about having family present that make the situation that much more real and human.  I was the one, in the end, doing chest compressions when the patient’s mother asked that we stop.  In that moment, I started to softly cry, and then I did what we always do… I grabbed a stethoscope.

There’s a ritual we perform as physicians when a patient dies.  In our increasingly high-tech, low touch profession, we pull out our very low-tech stethoscope, place it on the patient’s chest, and listen for a heart beat.  Sixty seconds… one full minute.  It simultaneously feels like an eternity and also almost as if time stops.

The strange thing is that in today’s modern medical world, we still perform this ritual to confirm death’s arrival, when we know all to well that the heartbeat will be absent when we listen.  Clearly in less sophisticated times this ritual was necessary, but our high-tech medicine and the long period of time spent resuscitating the patient to no avail already tells us what to expect… or rather what to not expect.

One of our chaplains during residency meets with us once a month to talk about ethics and the tough times we have during our training.  One of the questions he asks is how we deal with the pain, sadness, and tragedy that are all too common in hospitals.  Perhaps that’s the purpose of this ritual.  Maybe we listen in order to give us pause, allow ourselves to regroup and compose ourselves, and give us a moment to “deal”.  That one minute in time may be our chance as physicians to take one big huge collective breath.  Just maybe…

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