Taking call is difficult. The sleep never comes easy because you are always anticipating the phone ringing and the voice on the other end pulling you out sleep. Your heart races and your palms sweat as you repeat the diagnosis. “Gunshot to the chest? Are they in the ED? Did you call the rest of the heart team?”
The drive is always the worst. You look at the clock watching and waiting as you sit at a red light internally (and sometimes externally) muttering “Come on, come on, come on. I have to get there.” You park in the lot and sprint to the locker room to change. The minutes keep ticking but you just want them to stop. You have to remind yourself to breathe. You have to remember that this is someone’s child, but at the same time, forget that it is an actual person so you can focus.
Immediately after changing, you have to check the room to make sure all the medications and the minimum surgical instruments (a knife for incision, sponges to soak the blood, the saw to crack the chest, some sutures) are ready before you take a deep breath and run to the emergency department. When you get there, the room is chaos. The emergency room nurses are frightened and surgical instruments are opened: a million of them, more than anyone needs. The surgeon looks up, “Thank goodness you’re here. Load some silk sutures and keep them coming. Have them find the internal paddles. I can’t find the bleeding.” You keep reminding yourself to breath. You keep hoping to find the bleeding so we can move to the safe haven of the O.R. In the O.R. sterile technique is second nature; here, you have to ask for everything you need and make sure it is handed to you properly.
Finally the paddles come. You watch as the surgeon massages the heart and stops to shock it. Nothing happens. It doesn’t fill. You’ve never seen a heart look so limp and lifeless before. We try again and again. Finally, on the fifth shock, the heart fills slightly. There is a weak, slow heartbeat. It’s enough to make the call to use sterile towels to pack the chest and sterile drapes to give this boy some dignity as we run down the hall. We run as fast as anyone can with an IV pole, a rapid infuser delivering blood, and the bed will allow. It isn’t fast and it never feels fast enough. We get there and surgery begins. He goes on bypass. You remind yourself to breathe. He comes off bypass. You hold your breath anticipating all the things that could go wrong. He makes it to the critical care unit.
Then, you get a phone call a few nights later. He’s crashing. We need ECMO to bypass his lungs because they are filling with blood. “Get here now!” You remind yourself to breathe again. You get there and it’s chaos. Someone is getting him re-intubated. Someone is setting up the ECMO. “We need to do compressions!” As you are doing compressions, you can’t help but breathe in unison with the anesthesia provider bagging him. Counting calms you. You watch the monitor. He’s in sinus as you compress but goes asystole the second you stop. You keep going and going. Time seems to stop because all you can do at that moment is make this boy have a heartbeat. You are his heartbeat. We get him on ECMO and wait for the flight team. You keep reading the numbers and sending up silent prayers. “If we can just get the flight team here…if we can just get him into the helicopter…if we can just get him to the next hospital….” That call comes. The one that you know it’s bad. The one filled with silence that you can fill in the blanks yourself. “We lost him.” You cry. Your family knows it’s bad but they do not truly understand. You lean on your co-workers. We have a debriefing to discuss what we did right and what we should do next time. There’s always a next time. But you cry for this life you couldn’t save and his family that has lost their son. You know you can’t save them all, but you wish you could, so you grieve each loss like it has happened to you. That is how you know you are where you are supposed to be.
When the losses stop hurting you mentally and physically breaking your heart, the compassion in you has gone. For now, you go home and are thankful for everyone in your life. You learn to cry about it, but remember the blessing that you have to touch each patient. You learn to be grateful for all the lives you can save because of the medical knowledge you possess and the resources at your disposal. Each case teaches you a lesson and builds you into the person you are supposed be: strong, dedicated, compassionate. That is what all the training and all the life-saving techniques ultimately do. You become a beacon of strength in difficult situations- reliable and calm. You do everything in your power to fix everyone and every situation. You learn to empathize with others when the situation turns out well and when it is poor. Training is key in all of this because it gives you guidance and assurance that you can handle what comes your way.