This morning was formal rounds, with the attendings. One by one they left for clinic, till the remaining team members were down in the ICU. The chief’s pager went off. After answering the phone, she started running up the hall, calling over her shoulder, “Mr. Abbott is arresting!”

The junior resident and the medical student and I ran off after her, tearing through the crowded back hallways around the ICU till we got to the elevator, to go up several floors. Of course this would be the moment when the elevators absolutely refused to come to the floor we wanted, and when we finally got one, it was crowded, and already
punched to stop at every single floor on the way up. Part way there, the chief left with everyone else, and we saw her running towards the stairs, muttering, “Medicine residents coding my patient. . .” (Apologies, medicine folks; yesterday one of the medicine seniors wrote in the chart that our patient had rebound tenderness and peritonitis, when of course he didn’t have anything of the sort. . .)

Finally, we all arrived in the room at the same time, and found that another surgery resident had been on the floor, and things were fairly organized, but not looking good. As we struggled through the ACLS algorithms, all I could think of was, This was the first patient I met, at 4am yesterday, on this service, and he smiled, and didn’t complain about being woken up early. The first patient, and after only one day I felt like I knew him pretty well; and now . . .

During pauses in the code, while one person was doing compressions, the anesthesiologists were bagging, and everyone else was waiting to see if the most recent drug would help, we asked the nurses what had happened. Most of us had been in before attending rounds started; we had talked to him, more or less (the med student most, of course). He had seemed fine. And now all of a sudden, he was “found down.”

After a long time, it became obvious that his body was becoming colder and grayer under our hands, and nothing we were doing was making the slightest difference, or getting the tiniest response from him. (I hate dressing up for surgery work. It’s very awkward to work a code wearing a skirt and a necklace.) The attending and the chief agreed that they couldn’t think of anything else to do, and called the code. We filed out of the room, fiddling with our coats, or the pieces of paper and plastic scattered around the room, suddenly all ignoring the man who a moment before had been the center of attention.

We called the family members, who had not been in the hospital, and had to break the news over the phone – what an awful way to announce someone’s death. (I admire the way the attending didn’t push this job off on to the chief, but did the talking himself, in a straightforward and honest way.) They consented to an autopsy, and this afternoon we trooped down to the path lab to see what would happen. Which was fairly awful. You would think it would be hard for blood and dissected body parts to bother surgeons, but seeing our patient’s body spread out in the morgue was very disturbing. I think it was his face, which was quite still, and rather sad, not quite accusing. Usually surgeons are very careful to cover people’s faces before getting down to business. It didn’t make things any better that the pathologist discovered a problem quite the opposite of what we were expecting, which there had been no clinical warning of, and which ought not to have caused sudden death.

I feel horrible for the chief. She’ll be presenting yet again at M&M. She takes these deaths very personally (as she should). To me, even though I was starting to feel a connection to this man and the others on our service, they’re still not quite mine. They’re the attending’s patient, or the chief’s patient, and I’m taking care of things on their behalf. But for the chief, this was her patient. She had operated on him, had watched him carefully for several days post-op, had been looking forward to sending him home soon. . . and he’s dead. And yet, in a way, there’s a good side to the story. They had been unable to completely remove his cancer, which had turned out to be very invasive. Even if he had survived this admission, he would be dead within a year, probably quite miserably. But instead, he died quickly, and in fact without ever having to hear that he had metastatic cancer. That’s perhaps not the worst possible outcome; but it wasn’t our plan.