A Gentle Last Gesture
I wish we hadn't had to resuscitate her, that she could have gone to the grave with her ribs intact. This patient's life was over, my career just beginning, and I hope I never forget that sometimes death unimpeded is a blessing.
By Laura Fitzpatrick MD, Contributor
Dermatology resident in New York
Sep 23, 2015, 11:49 AM EDT | Updated Dec 6, 2017
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"Do you want to do CPR?" my supervising physician was asking. A minute earlier, the ambulance bay doors had whooshed open to admit three paramedics wheeling a gurney. Their elderly charge, a thin white-haired woman, was lying next to us now, unresponsive, with doctors and nurses buzzing around her.
I had only ever done CPR on a plastic dummy, but I stepped up onto the stool, replacing the paramedic who had already been doing chest compressions for several minutes. Leaning over her torso, I dug the heels of my hands into the frail old woman's sternum. I pressed down rhythmically, humming the Bee Gees' "Stayin' Alive" in my head to keep the pace, as--I kid you not--we are taught to do in medical school. Under my hands, something felt sharp. It only occurred to me later, when I traced the smooth contours of my own ribs for contrast, that by then the patient's ribs had probably been broken. CPR is lifesaving, especially in patients who go into cardiac arrest outside a hospital, but some studies show that at least a third of patients who get it will wind up with at least one broken rib. This woman, who was over 90, was unlikely to escape a fracture.
"She's DNR," one attending said. "But we don't have the paperwork." One of the nurses went to the phone at the nursing station to try to contact the woman's family.
I kept pushing on her chest. Next to me, my attending made sure the heels of my hands were in the right spot. "Nice and steady," he said. "Keep the pace." A medical school classmate was next to me, ventilating the patient with a bag and mask to keep her lungs inflating as I tried to make her heart beat. We waited for the nurse to report back about the DNR. I was puzzled, and I guess my face showed it. "This is just a gentle last gesture while we wait," the supervising physician murmured.
The patient's eyes were open.
Finally, someone got the son on the phone. Holding up the receiver, a nurse said, "you can stop." One of the doctors called the time of death.
We trickled out of the resuscitation area, the last doctor drawing the curtain behind us to shield the woman's body from view. Among the seasoned doctors and nurses, who had surely been part of this kind of scene before, the talk quickly turned back to the day's business. As I checked on my other patients, my mind kept flashing to the dead woman lying behind the curtain. A couple of patients, waiting to be checked on, complained that it had been too long. Someone just died over there, I wanted to say. We were busy. Then one of the attendings came over and gave me pointers on my CPR technique. More patients came through the door.
An hour or so later, I saw three women disappear behind the curtain. Frantic and crying, they had come to say goodbye.
It was the last day of my third year of medical school. Standing on the subway platform to go home with my classmate that night--the one who had ventilated the patient--she and I talked over those moments when we had tried to keep our patient's heart beating and her lungs inflating. I began, "She looked so..." and my classmate chimed in: "dead." I wish we hadn't had to resuscitate her, that she could have gone to the grave with her ribs intact. This patient's life was over, my career just beginning, and I hope I never forget that sometimes death unimpeded is a blessing.