When I first started residency I decided I would write.
I started a journal, planning to fill the pages with stories of happiness and joy, fear and sorrow, and of hope. I felt that the stories of my patients would help contribute to the demeanor of my future practice. I thought that to reflect on the moments that moved me, made me smile, make me cry, or made me think I could maintain the attitude with which I began my residency journey- an attitude of compassion.
The stories began with titles:
“The Patient with no Advocate”
“The Patients Who have been Failed by our System”
“The Patients Who Wanted to Die”
But then I stopped writing for about a year. There were many excuses I made to myself about being busy, but there was one particular story that kept me away. A story I wasn’t ready to write. I had written lines of that story in my head, had flashbacks, and relived those moments, but that story had remained buried. Emotions do not bury well.
Young or old, expected or unexpected, death always hurts- some times more than others, but it always hurts.
On this particular day, 3 patients would die in 3 hours. I remember getting report on the first- differing versions of the same story. Teenage boy, trauma, compressions in progress.
Going through the motions: gowning up, airway set up, standing at the head of the bed.
EMS arrives. So much blood- face covered, mouth full.
Compressions continue, airway placed, asystole.
Chest is opened on both sides- hardly indicated- no change.
But what else are you going to do when you’re watching a child die.
I stand fearful, a pit in my stomach, knowing what comes next.
Time of death.
The room empties, the sea of people flood out of the room, past 2 figures waiting outside the curtain.
I can still hear the shrill, a sound like none other, the sound of a mother screaming for her dead son.
A woman falls to the ground.
I cannot bear to walk past her.
And so I side step into the next trauma bay to find a gentleman barely responsive with a blown pupil. My next patient has arrived.
My mind in room 3, my body in room 2.
I take a moment, sitting outside for a few minutes- taking in the sun of a beautiful day before walking back into reality: a life cut too short, another taken by cancer, and a third whose time had come to an end.
A year later, this day still brings tears to my eyes.
As I start the third year of my residency, I reflect on how much I have learned. I can manage a respiratory arrest, competently perform procedures, evaluate EKGs, and teach my juniors to do the same, but I haven’t discovered the answer of how to find balance in compassion. There’s a fine line between losing that empathy and internalizing the significant emotional trauma that we may experience alongside the family members of our patients. How does one walk that tight rope and avoid falling off the cliff on either side? I think the answer to that is different for everyone and that each of us will fall from side to side throughout our careers. For me, for now, I’ll continue to write.
Ashley Mogul is a third year resident and the Academic Chief at Stony Brook.