I see dead people

Deceased. It just popped up on my patient list next to her name. That was it. Done. Not that we hadn't know this was coming, she was in the ICU and had been deteriorating for weeks but it seemed like an abrupt ending. She had come in off the street, initially admitted for psychosis (i.e. craziness) she had then slowly lost consciousness and developed sepsis. Kidney failure, liver failure, and a mushy brain . . . all just kind of unexplainable. I had seen her several times, they were trying to rule out any gyne causes. Then suddenly 'deceased' on my list. Everything felt numb. I have trouble imagining people dead, since all my memories of people are so alive.

I'm in obstetrics because I don't like sick people and I don't like dead people, its simple. 95% of the time, you get a happy healthy mom, a gurgling happy baby, and a proud as heck dad out of the deal, its all happy clappy. Patients hug you and take pictures of you and buy you cherries and chocolates and cinnamon buns. But today was different, it was just a bit soul destroying. To call it tragic and heart-breaking doesn't even begin to describe it. My day started and ended with the same word.

The woman came is last night, 28 weeks pregnant and with horrible abdominal pain. So much that we couldn't even examine her without giving morphine, screaming out in pain. The first thought was abruption, bleeding in the uterus when the placenta pulls away from the wall. But baby looked fine, all the lab results were normal, just excruciating pain. She had been into the emergency room twice before with similar pain, chalked up to constipation, it resolved, and she went home. We were just talking about her in rounds when I got paged. A distressed emergency doc was on the phone. "She's gone tachy, she looks terrible, and I can't get a fetal heart. I need you here now."

I grabbed a senior resident, realizing immediately this was way out of my league. Within minutes we knew. It was an IUFD. We talk in code. Intra-uterine fetal demise.

She's white as a sheet, snowed on morphine but still in pain, heart rate through the roof. Ultrasound is repeated, its now been done four times. I've seen dozens of scans and there's nothing as bone chilling as seeing the spine and rib cage with no tiny heart moving up and down. The husband stands by the stretcher in the trauma room, squeezing her hand, stroking her hair. Her fingers look so pale they are nearly translucent in his strong brown hands. We walk in and out of the room, hushed tones, "get the attending here stat." It seems sick and twisted that we can't tell the husband until we've dotted all the i's and crossed the t's. "Medico-legally imperative" I'm told. A wave of nausea sweeps over me, I'm disgusted at the system I am so actively a part of. A husband is watching his wife writhe in pain, knowing that something is wrong with his child, asking and asking but we can't officially tell him. Frustration, anger, pain.

Finally they know, her eyes dart around the room, I see terror and confusion in her eyes, it makes no sense. The father, well-built and articulate chokes with emotion. "But it was fine, 8 hours ago the baby was fine. How did this happen? The baby was fine!" Why, why, why? Dozens of questions, anger spilling out at this injustice, this tragedy of horrific proportions. Talking to the emergency physician her eyes well up and she holds her head in her hands. She was on all night, saw the patient when she came in and woke her up this morning to check on her. "Let's play the what-if game, what did I miss?" The answer, for now, is nothing. Because no one can carry that weight on their shoulders without being crushed.

As if the loss of a child is not painful enough, the initial plan was to induce labour. An emotionally laden process.

That didn't happen, mom 'crashed'. She was rushed to the OR for an emergency C-section. Dead baby out. Uterus sewn up. Then all they can see is black small bowel. Five feet of dead gut. That's what caused her pain. General surgery comes in, of course you can't live without a gut, so they sew her up and send her to ICU, intubated, ultimately to die.

Numb. A man has lost a child and then his wife, can life ever go on? She's someone's daughter, someone's sister, someone's best friend and she would have been a mother. He thought she was constipated and now she dead.

I want a debriefing session, to sit with everyone involved and talk of the horror, to reassure each other that we didn't miss anything. I want to process this, to try to understand what just happened. But my pager just keeps on going off.

I'm called to see a distressed woman, emotional and crying after bleeding for weeks after a D&C for a miscarriage. "I just want it to be over, I need closure. This isn't fair, I still feel like I'm pregnant, my breasts are still full, but I keep on passing these clots. When will it be over? Is it blood? Is that a piece of baby coming out? I can't handle this, I need it to be over." Sobbing, nearly hysterical. I listen and listen, and empathize and reassure and book her for the OR for another D&C. I don't even leave the ER before I get grabbed for more consults. A cyst next to someone's urethra (yawn), bleeding that won't stop, pain and pain and pain. Then a woman who blacked out and rolled her car . . . and is 16 weeks pregnant. Scared. A broken arm, a worried husband.

If anyone says that the medical system is uncaring and doesn't feel pain I will dispute it with passion. All day in the emergency department, in the halls, on the maternity ward, nurses, residents, and attendings stopped me to ask if it was really true. If this unbelievable tragedy had really happened right in front of our eyes. It was as if as the first obstetrics resident on the scene I could offer some insight, some reassurance, a person they could identify as a place to share their grief. If I could have stepped out of my own emotions around the issue I probably would have found it fascinating.

I keep going and going, trying to fully engage with each person and their own personal pain but I'm drained. I have nothing more to give. Numb. As I write up the notes I find myself zoning out and starring at the page without focusing. By 4pm I can't stop my hand from shaking as a pick-up the phone to return a page. At that point I realized that I hadn't eaten or had a drink since 5:30 this morning. In fact, I hadn't even peed since then, what am I? Superhuman? At which point I raid the limitless supply of egg-salad sandwiches and potent orange Tang in the ER fridge.

This is the worst job on earth, there's nothing but pain. Why can't I make lattes for a living, where a bad day means that I used 2% instead of soy and the espresso machine is broken?

But at the end of the day, I get to go home. To splurge on creamy Greek yogurt and stacks of local blueberries. I pound out every ounce of anger, sadness, and sheer emotional exhaustion into the pedals of my bike. Disappearing into the thick cool forest of the endowment lands, skidding around corners, speeding down the hill to the ocean and along the coast. I can leave that pain behind and start a new day, but they can't, because ultimately its their pain and not mine. I can only try to share it with them when I'm present in their reality, in some watered-down version. No, I don't really want to make lattes, I want to be present with people in their pain, this is real, this is life.