We Are Not Gods
I had a God complex.
It was 2005, and I had just graduated US Army medic training. Looking back now, I suppose most people suffer from the same complex when they first become medical providers.
The fairytale storyline of the medical provider miraculously saving every patient they see is perpetuated by popular media and often not dispelled by our training. If you need any evidence, just flip on your television and tune into any number of shows showcasing miraculous medical interventions.
A surgeon, working on a truly hopeless case, saves the day in a dramatic montage.
An exhausted doctor peruses the isles of a convenience store, searching for a snack. He casts his chips aside when a stranger calls out for help from the candy bar section. "Somebody call an ambulance!" they shout... but there is no need. Our white-coated hero glides in, performs a cricothyroidotomy with a pen from the purse of a swift-thinking old woman and, shortly after, walks out of the store beside his patient. The doctor has his chips, the patient has a small bandage, a miraculous story and a lifetime of gratitude.
In medic training we are taught that it only takes 2 minutes to bleed out from a lacerated brachial artery and 1 ½ minutes from a femoral artery. The implication being that if we get proper pressure on the pressure point and a sufficient tourniquet on in that time, we will save the patient. With the right tools and speed on our side we could save anyone.
We were the angels of the battlefield, holding death at bay and snatching the wounded from the pearly gates!
Death happened, of course, but only if you'd missed something or made a mistake. We were fallible gods, but gods nonetheless.
That lasted 2 weeks.
While working one of my first ER shifts, a gentleman I’ll call Jim (not his real name) was rushed through the doors. He had called 9-1-1 23 minutes before, complaining of substernal crushing chest pain. He described the pain as feeling just like his last two heart attacks.
Paramedics in the area were able to get to him in 7 minutes, well within the vaunted platinum 10 minutes prehospital providers aspire to. Jim was in distress, but also in good spirits. He even joked with the paramedics as he moved himself onto the stretcher.
"Buy two heart attacks procedures, get one free, right?"
The paramedics got him started on oxygen, established IV access, monitored vitals and performed an EKG as they loaded him up and initiated transport. His wife bundled the kids off to grandmas and made her way to the hospital just like last time.
It was a new routine, and everything was going smoothly. Just like his previous visits.
Somewhere along the way, however, Jim’s condition started going downhill.
Midway through another joke he lost consciousness and could not be roused. He stopped breathing. CPR was initiated at a proper ratio of compressions to breaths. Shocks were delivered as indicated. Intubation went seamlessly. The paradoxical motion of belly and chest continued as a string of medics and nurses administered compressions, valiantly attempting to will this heart to restart. The protocol on the wall was followed to the letter.
10 minutes after he arrived, and well within the golden hour for definitive care, Jim was pronounced dead.
I couldn’t comprehend what had just happened.
This did not compute.
The more experienced providers went to tend to the other patients. It fell to me and another medic to sanitize the scene for his newly widowed wife, now crumbling under the news in the waiting area.
I placed a sticker with his name, date of birth and SSN on a white bag labeled "PATIENT BELONGINGS." I then folded Jim's clothes and placed them inside. They had been shredded by the trauma shears so that nothing would escape the discerning eyes of the medical team.
Tube after tube was removed and discarded. One tube for his airway was still warm and thickly coated with drool. One for urine, three now stagnant IVs with blood coagulating in the tips, and two on either side of the chest. We wiped him down and draped a new white sheet over the body that was Jim. Still warm, but now dead.
We did everything right.
I read and reread the chart. We got to him in time. I saw the CPR: it was correctly performed. Everything was done in time, with a precision I could only aspire to at the time.
And Jim died.
We were not gods. Not even close.
Death came for this man, and no amount of tubes, drugs, or savage thumping on his chest could stop it.
We had no chance once that clot broke loose and lodged in one of the arteries, feeding what remained of his functional heart.
I started researching statistics, looking for an answer. Every heart attack reduces the chance you’ll survive the next. Only 10-15% of people requiring CPR in the hospital will leave alive. Of those who do survive, many suffer a decline in mental and physical status as compared to when they came in.
It was a reality check of the worst kind. There are people that need help. There are people that will die without our timely and appropriate intervention. There are others that will -- regardless of who you are or what miracles you try to perform -- just die on you. Those that do survive their brush with death are better than if we had done nothing, but even they rarely achieve the level of health and fitness they had prior to the injury or illness that landed them in our hands.
Hooked to machines, heart persists in pumping blood around a motionless body. The ship sails on with no captain at the helm.
Does this count as alive? Where do we draw the line? When do we go from angels of mercy to wardens of souls trapped in bodies on the brink? At what point do we call it and move on?
As an EMT, this quickly became the problem of medical direction. Some physician, often at a distance, had to judge our efforts by telephone and render final judgement. Sometimes they’d wait until we rolled through the doors, perspiring from the effort of potentially life-saving care, only to confirm what we already knew: they didn’t make it.
As I become the physician that will make those calls, I will always remember that day. The day Jim reminded me that, despite all the training, all the science and all of the miraculous advances in medicine, we are all human.
We are not gods. Death comes eventually. Sometimes knowing how to save someone takes a back seat to knowing when to let go and finding the strength to let them pass in peace.
Note: This blog was written as part of preparation for “What Matters in the End” week March 26th-30th, 2018. For more information on the "What Matters in the End" reception, which is open to the public, click here.
Osteopathic Medical Student - 1st Year (OMS I)
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences