first death

The room is silent.  The attending physician sits somberly, rather incongruously perched atop the cream-colored lid of the refuse bin.  The two medical students inside the room stare silently at the ICU monitor, periodically silencing its insistent beeps.  The patient herself lies unnaturally still, the breathing tube still protruding from her mouth.  She had jumped off a building today - a suicide attempt that would, with some delay, succeed.

* * *

He explains to us, "Our first priority is always the patient.  We took her off the ventilator.  It is slippery ethical ground to put her back on, even for the sake of the family."  Although that time might give them comfort, it would extend the patient's dying process.

They used a Reboa, an aortic balloon, to stabilize her blood pressure, at the cost of cutting off blood to her intestines and lower body.  There was no way to fix her in the operating room enough to take the Reboa out.  The team had decided that her condition was incompatible with life.

We (vascular surgery) came to see her because, after all, the largest blood vessel in her body (the aorta) was involved.

* * *

The blood pressure drops lower and lower, from the 31/40 to the tens and then single digits.  The rise of the patient's chest, obvious when I first arrived, becomes invisible.  The respiration rate becomes zero, and slowly, the blood pressure drops lower and lower, hovering at 5, 7, 3, 2, 1, and finally, nothing.

There is no ceremony, no checking of the pulse with a stethoscope, opening the eyelids and checking pupillary reflex, no listening to the respiration rate.  The monitor already told us what we knew: the patient was dead.

The attending pulls out his cell phone to check the time, then tells us and the nurses waiting outside,  "The time of death was..." and the exact minute of her death. 

* * *

I had wanted to take the patient's hand and tell her, "You are loved.  Rest well.  You will be at peace soon."  What kind of pain and driven her to take her own life?  Could she hear, anyway?  I rationalized that she would not.

But I was too afraid to do so, afraid it was not appropriate, fearful to look into her face and caved-in skull and burn that into my own memory.

 She was not my patient.  I only had met her in the last moments of her life, the final process of dying.  But she did not die alone.  We strangers stood vigil.

 * * *

A classmate of mine took his own life in a similar way.  Being a resident, he probably knew enough to ensure that he was well past the 60-foot margin of survivability.  He certainly did not make it to any emergency room.

* * *

I cried in the garden about the death of this stranger.  

I don't know whether I ever cried about my classmate.  It felt as if he had stepped off the roof and into oblivion.  Nobody invited us to any kind of memorial, nobody acknowledged his death, nobody told us who he was until we had read the tabloid articles that contained far more detail than I would ever wish to know.

I perhaps spoke to this classmate a handful of times, but it wasn't right that his death was never acknowledged.  There was no closure.

This woman whom I never know - I watched her die, quietly and peacefully, her vital signs trailing off to zero.  But I thought of my classmate.  He did die - in a purposeful and intentional way, for reasons I do not know, in pain so great that he thought death was preferable.

In writing today, I kept writing that the patient was a "he".  In my mind, the patient is my classmate, and my memory keeps conflating the two.

* * *

Today was hard.  It was my first death.  I wish it had not been a jumper.