In my travels I've had the opportunity to meet many wonderful and amazing people. One of my all time favorites is a friend named Graham, pictured above at my farewell to NYC party. Graham Walker, ER resident extraordinaire ;) He was a 2nd year intern at St. Luke's in Manhattan where I worked two summer's/fall ago. Amazing person, amazing friend, amazing physician. And extremely great with words. You can follow his words blogs and general information here, here, or here. Oh, and did I mention, he's brilliant? In particular today I am reminiscing about a 'note' he wrote and published to his Facebook account almost 2 years ago today. It was entitled 'Reboot' and you can find the link here. The words are as follows.
"I'm always amazed at how much the ED can just keep going after some code or major trauma or absolute train wreck. Not just at how we physicians can mentally re-orient ourselves: 'Current task over, return to other patients now,' but the entire department. The housekeepers keep housekeeping, the nurses keep nursing, the techs keep teching; the controlled chaos returns after a sudden eruption of hell breaking loose.
"This is especially true and eerie after a death. Someone utters, 'Time of death eleven thirty-seven,' and it's like you've just rebooted our minds. We return from whence we came, doing what we did before, but now maybe a little sadder, a little more downtrodden, and a lot more behind. We whisper something to ourselves, pausing for a few seconds to grieve, and keep moving. Try to save the next one.
"A couple hours later, the body has been packaged and removed and the room is completely cleaned. Fresh. A new patient sits in the gurney, dangling his legs off the edge of the bed, wondering when he's going to be seen. He has no idea what just went on two hours ago in the exact same place. You briefly make eye contact as you walk past the room. Ignorance is bliss.
"The room is back to how it always is, with nothing left but your memories of what just happened. How you broke the poor woman's ribs at 100 beats per minute. Crunch, crunch, crunch, crunch, crunch. How you stuck sharp things in her mottled, edematous frame. How before all this, you stuck the tube in her throat and figured things would start turning around once you controlled that airway. And then an hour later, how you ran through your differential one more time, everyone straining their brains as if there's some obvious procedure or drug or incantation you must just be forgetting that instantly resurrects the dead:
What?
Am?
I?
Missing?
You sigh. And then you call it.
'Time of death, eleven thirty-seven'
Reboot"
I love this. There are many things that you just have to experience to truly understand. The way that the workers in the ER are like the closest of close-knit families. But I think that even if you don't really get the 'reboot' post in the same way us ER peeps might, you get the gist. Last night at work after coding a patient intermittently for 2 hours and starting him on every drip known to man, the code was called. The doppler had been used to attempt to hear any discernible traces of remaining pulses in the soon-to-be deceased man. The ultrasound is brought in to confirm that there are no remaining traces of cardiac activity. The code is called. Reboot. New patients are waiting. As are those that were waiting while we were breaking ribs and drawing blood and pushing fluids and medications.
So I went to see my new patients. Medications were ordered on a patient 18 weeks pregnant who had urticaria of pregnancy. As were fetal heart tones. I grabbed the doppler, taking a moment to appreciate the irony of what the machine was last used for. I wheeled it into the room, gooped on the cold cold jelly and placed the doppler to the patients pregnant abdomen and heard a solid rapid thump thump thump thump thump. Humming along at a healthy 148 beats per minute. I left it there several moments longer than necessary. I love listening to fetal heart tones. I just think it's amazing. To hear a happy healthy baby's heartbeat while it is in an innocent blissful place doing nothing but growing fat and happy to make it's debut into the world. And it was especially reassuring at that moment. The circle of life and all that. The very machine I had used not ten minutes earlier to confirm the death of one man, was at that moment confirming the healthy fetal life of another. Reboot indeed. Life goes on. I have the greatest job in the entire world!
"I'm always amazed at how much the ED can just keep going after some code or major trauma or absolute train wreck. Not just at how we physicians can mentally re-orient ourselves: 'Current task over, return to other patients now,' but the entire department. The housekeepers keep housekeeping, the nurses keep nursing, the techs keep teching; the controlled chaos returns after a sudden eruption of hell breaking loose.
"This is especially true and eerie after a death. Someone utters, 'Time of death eleven thirty-seven,' and it's like you've just rebooted our minds. We return from whence we came, doing what we did before, but now maybe a little sadder, a little more downtrodden, and a lot more behind. We whisper something to ourselves, pausing for a few seconds to grieve, and keep moving. Try to save the next one.
"A couple hours later, the body has been packaged and removed and the room is completely cleaned. Fresh. A new patient sits in the gurney, dangling his legs off the edge of the bed, wondering when he's going to be seen. He has no idea what just went on two hours ago in the exact same place. You briefly make eye contact as you walk past the room. Ignorance is bliss.
"The room is back to how it always is, with nothing left but your memories of what just happened. How you broke the poor woman's ribs at 100 beats per minute. Crunch, crunch, crunch, crunch, crunch. How you stuck sharp things in her mottled, edematous frame. How before all this, you stuck the tube in her throat and figured things would start turning around once you controlled that airway. And then an hour later, how you ran through your differential one more time, everyone straining their brains as if there's some obvious procedure or drug or incantation you must just be forgetting that instantly resurrects the dead:
What?
Am?
I?
Missing?
You sigh. And then you call it.
'Time of death, eleven thirty-seven'
Reboot"
I love this. There are many things that you just have to experience to truly understand. The way that the workers in the ER are like the closest of close-knit families. But I think that even if you don't really get the 'reboot' post in the same way us ER peeps might, you get the gist. Last night at work after coding a patient intermittently for 2 hours and starting him on every drip known to man, the code was called. The doppler had been used to attempt to hear any discernible traces of remaining pulses in the soon-to-be deceased man. The ultrasound is brought in to confirm that there are no remaining traces of cardiac activity. The code is called. Reboot. New patients are waiting. As are those that were waiting while we were breaking ribs and drawing blood and pushing fluids and medications.
So I went to see my new patients. Medications were ordered on a patient 18 weeks pregnant who had urticaria of pregnancy. As were fetal heart tones. I grabbed the doppler, taking a moment to appreciate the irony of what the machine was last used for. I wheeled it into the room, gooped on the cold cold jelly and placed the doppler to the patients pregnant abdomen and heard a solid rapid thump thump thump thump thump. Humming along at a healthy 148 beats per minute. I left it there several moments longer than necessary. I love listening to fetal heart tones. I just think it's amazing. To hear a happy healthy baby's heartbeat while it is in an innocent blissful place doing nothing but growing fat and happy to make it's debut into the world. And it was especially reassuring at that moment. The circle of life and all that. The very machine I had used not ten minutes earlier to confirm the death of one man, was at that moment confirming the healthy fetal life of another. Reboot indeed. Life goes on. I have the greatest job in the entire world!
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