Tonight is one of those.
A thirty-two-year-old male walks in complaining of abdominal pain, and after scans and bloodwork, I admit him for a mass in his lower intestine that抯 more than likely advanced stage colon cancer.
An eighty-five-year-old woman with no living relatives gets wheeled in from her nursing home in acute heart failure. She has a DNR, so the only thing I can do for her is put an intern at her side, holding her hand, until she slips away.
Paramedics call in an MVA and eight minutes later they rush in, doing compressions on an intubated twenty-year-old who swerved to avoid a deer and ended up hitting a telephone pole, while not wearing a seat belt.
I let the ED resident梟ot an intern, but still a baby doctor梤un the trauma.
揝hock again at three hundred. Clear.?
The patient jolts as she shocks the heart for the third time and we look to the monitor for a miracle梩o see if a rhythm appears. When it doesn抰， she tells the nurse, 揅harge to three sixty.?
揥ait,?I intervene. 揌ow much epi have we given him??
揊our.?Skylar抯 tone is solemn because she抯 a veteran trauma nurse, so she knows where this is going too.
揌ow many transfusions??
揟hree.?
It doesn抰 matter how much blood we give him梚t抯 coming out faster than we can get it in.
揌e抯 gone.?I shake my head. 揌e was gone before they got him here.?
The resident抯 dark-green eyes jolt up to me, then she looks down at the patient and calls the time of death.
揑s the family here??I ask.
揟here抯 a mom,?Tanner says, turning off the monitor. 揝he抯 in the private waiting room.?
揇oes she have anyone with her??
揘o, she抯 alone.?
揋oddamn it.?I yank at my gown, balling it up and shoving it in the bin. 揅all Pastoral Services, have them send someone down.?
Fifteen minutes later, in clean scrubs and a white coat, I stand outside the door to the small waiting room with Chaplain Bill on one side and the resident on the other.
揇on抰 say anything,?I tell her. 揑抣l do the talking.?
There is nothing on earth that could make this conversation better梑ut there are things an inexperienced doctor can say that would make it infinitely worse.
I walk in the room where a petite, light-haired woman sits in a chair in the corner. When I was young and green, I would抳e wondered why she抯 here by herself. If she has a husband or other children . . . or if her son was her entire world.
I know better than to think about those things now.
揗s. Allen??
Her face lifts expectantly.
揧es??
I move forward, stopping two feet from her chair梬ithin reaching distance.
揑抦 Dr. Connor Daniels. I抦 the physician who treated your son, Brandon, when he was brought in after his car accident.?
揌ow is he??she asks. 揅an I see him??
I look into her eyes and make it quick, even though that won抰 make it easier to hear.
揗s. Allen, Brandon was critically injured when he was brought in梙is heart was not beating. We gave him medicine and blood transfusions and used every tool and technique available, but I抦 sorry to have to tell you that his injuries were too severe . . . and Brandon died.?
It抯 important to use the actual words. Dead, died. It抯 brutal, but euphemisms breed hope and there is no room for hope here.
She blinks. They all blink at this part梚n that short, hazy window of time before the words sink in and make sense梐nd their lives are forever changed.
揃ut . . . I just saw him. I talked to him. He was fine.?
揑 know.?
She shakes her head.
揌e was going to the store. He抯 on a new weightlifting diet and I forgot to pick up chop meat this afternoon.?
揑 understand,?I tell her. 揑抦 so sorry.?
揥ait. Are you棓
She tries to stand, but her knees give out. I catch her before she goes down, holding her up.
揈asy . . .?
Her fingers twist in my coat and she wheezes for breath, like I抳e kicked all the air out of her lungs. She lowers her head and tries to scream but she can抰梠nly a strangled, suffocating gasp comes out.
When you do this long enough and the years go by, you forget the names. But you never forget their faces. The sounds they make when you tell them. Jagged, incomprehensible sounds filled with horror and grief.
If hell exists . . . I think this is what it sounds like.
I guide her back into the chair but she holds onto me, her eyes desperate and darting.
揂re you sure it抯 my Brandon? Are you sure he抯 really . . . that he died??
I don抰 look away; I meet her gaze directly梑ecause she needs this.
揧es, I抦 sure it抯 Brandon. He died. I抦 deeply sorry.?
Her hands fall away and the life goes out of her. She stares, unseeing, at the floor and she won抰 hear anything I say now, but I tell her anyway.
揟his is Chaplain Bill. He抯 going to stay with you, and help you with the next steps.?
She doesn抰 answer; she doesn抰 blink. Not anymore.
I turn and walk out the door. I don抰 stop walking until I抦 around the corner at the end of the hallway梤eminding myself to breathe.
At my elbow, the resident is on the verge of losing it梙er cheeks red, her eyes full.
揇o not fucking cry,?I order, sharp and mean. To snap her back梞ake her refocus. 揘ot here, not now.?
She sucks in a shuddering breath, trying.
揑抳e never . . . that was the first time I棓
揙kay.?I nod, guiding her to lean over slightly. 揃end your knees and breathe. Three deep, long breaths. Come on.?
She inhales, slow and shuddering, eyes closed. Then she does it again, shaking her head.
揟hat poor woman.?
揇on抰 think about it.?
揌ow do I not??she rasps.
揚icture . . . a safe in your mind. Thick, steel walls and one of those huge locks like the vault at a bank. And you take Ms. Allen and everything you抮e feeling and you put it in there梐nd you shut the door, lock it up. Because we have three other patients waiting. Maybe three other Brandons that you can still help, three more chances to not have that horrific conversation. But you can抰 treat them if you fall apart. If you抮e distracted and upset and your vision is blurred.?
She nods, inhaling slowly again.
揥hen you抮e home, later,?I tell her. 揥hen you抮e in the shower or in bed梩hat抯 when you open the safe. Let yourself feel it梱ou won抰 want to but you need to. Because this job isn抰 about saving everyone梚f you go in with that as your expectation, your career in emergency medicine is going to be epically short. The job is to keep going . . . knowing you can抰 save everyone.?
She stands straighter now, head lifted, breathing steady and eyes clear.
揙kay.?
揧ou good??I ask, just to be sure.
揑抦 good.?
I take the chart from the wall outside the exam room door.
揟hen let抯 go.?
*
I stay at the hospital an hour past my shift to catch up on notes and charts. By the time I walk through my front door at 10:30 a.m., a heavy exhaustion has settled deep into my bones. It抯 more than just physical. I can barely muster a smile for Rosie when she greets me, her nails tapping the wood floor as she trots over to drop a mangy stuffed turtle at my feet.
But then I take a breath . . . and I抦 infused with a deluge of delicious, sugary-scented goodness. The whole house smells fantastic, like a bakery梑ut in heaven.
I wander toward the kitchen like a damned soul in search of the light.
Violet stands at the stove dipping a wooden spoon into a large heated pot. She抯 wearing my gray T-shirt, tied at her stomach, and a pair of my black sweatpants that are huge on her梩he waist knotted with a rubber band at her hip to keep them up. Her hair抯 in a messy chestnut pile on her head, and though her shape is lost in the mammoth clothes, she still manages to look sexy and adorable.