The hidden gem

TW: drug mention, self-harm.

The pager erupted with a series of short shrilling beeps. I took it out of my pocket – the night call person handed it to me in the morning with a belt holster heavily remedied with medical tape but still incurably broken. I meant to walk to the communications to get a new one but never got to it, and now, at five p.m., they were closed for the day.

The screen read “Full trauma code Resus 1 bed 2.” In the few next minutes, a seriously injured person will be rolling into a large resuscitation room in the ED, short for Emergency department.

As the shiny elevator doors started sliding closed, a blood bank tech stopped their motion with his arm through the gap. The blood fridge rolled in. It always has four units of red blood cells and four units of fresh frozen plasma, because trauma patients often need a blood transfusion right upon arrival. The tech and I recognized each other with silent nods. The technician with a blood gas analyzing machine didn’t make it – she will take the next elevator. Her services won’t be needed in the next five minutes, anyway. I took a deep breath, grounding myself. Time will start stretching the moment I step out of the elevator. I need to be present, aware of every second until the trauma team is dismissed.

Most of the crowd is already at the trauma bay, wearing light blue plastic isolation gowns, ready for action. I also don a gown and slap a large orange sticker Anesthesia on my chest.

“What’s the story?” I ask the stocky guy with a sticker reading ED Attending. He must be new because I don’t know him. A Lot of new people in the last year. I don’t know where the people I knew went, but I suddenly realize I must be the oldest person in the room. “When did this happen?” I think to myself.

He fills me in briefly, “High-speed roll-over car accident, car versus a tree, a woman in her thirties, driving under the influence.”

A tiny tightness releases from my chest. I didn’t even realize it was there, but I know it very well. It always grips my breath on occasions the story starts with “man in his early twenties.”

If that was the case, I would stay tense and anxious with a silent prayer in my head, “God, please don’t let it be my son.” The foreboding would last until the patient arrives, and I see that it is indeed not my son. Then, I can breathe again. I don’t know if other people with children feel the same way. It is a question I never ask.

“Medics at the door,” says the overhead voice. Everyone regroups to make sure the stretcher can come in easily. I stand on my tiptoes to see the head but only see a purple respiratory bag that the medic is squeezing rhythmically with his large hand. He keeps a steady pace, about 18 breaths a minute. For now, this is all I need to see. The patient is already intubated, so I move back to stay out of the way.

If a patient arrives without a breathing tube, I go to the head of the bed so I can assess whether one is needed. My job is to supervise a resident who will place the tube in, or do it myself if the first try fails.

I have many stories of failed attempts when I had to take over. I share those stories with the new residents to teach them what not to do, and how quickly things can go wrong. They always perk up and listen carefully - even the distracted ones get attentive for the story.

What I don’t tell them about is the cold and tingly sensation I feel between my shoulder blades right before looking down the throat of a breathless human, trying to push death away. The world slows down, goes silent and I hear my voice becoming hoarse when I ask for “suction” or “airway.” These are very lonely moments, and the young doctors will need to figure that out for themselves.

I don’t need to do any of this right now. I stand in the back and wait to see if the patient needs to be rushed down to the operating room. In that case, I will go with them.

All muscles in his black uniform, the medic recites the story, every word loud and clear. “No seat belt, twenty minutes extrication time, unconscious, intubated immediately. Veins are hard to get, pupils wide from the beginning, drug paraphernalia in the car, blood pressure low. Could not get good intravenous access to give fluids.”

The nurse attaches cables to the monitor. The signals appear on a screen as colorful jumping lines. The blood pressure is low, and alarms start screaming, and red lights flash. The line indicating the heartbeat looks funky.

“Check the pulse! “The ED doctor has the algorithm of actions imprinted in his brain. We all do.

“No pulse!”

“Start chest compressions!”

“Get in line for the chest compressions!”

“Put the defibrillator pads on!”

“Start blood transfusion!”

The human swarm around the patient appears chaotic but is a very organized process. A surgical resident places a large catheter, almost the size of my pinky finger, into the vein in the groin. The staff is reading out loud numbers printed on the blood units and connects the checked bags to a rapid flow device that pumps blood and plasma into the vein, unit by unit. The nurse hands out syringes with the emergency drugs, the assistant records doses and times, and someone else is drawing the emergency blood tests.

“Pause CPR, check the pulse!”

With beads of fresh sweat on her face, the nurse doing chest compressions steps back as another person takes her place. At the same time, another nurse feels for a pulse on the neck.

“No pulse!”

“Resume CPR!”

We go and go, round after round. A few electrical shocks are given in the hope of converting the erratic and ineffective heartbeat into a normal one. Large tubes are placed in the chest to release any potential air trapped inside which would compress the heart. It is all in vain. We watch the line on the monitor getting lower and lower, eventually becoming flat.

“How long has it been?” the ED doctor says in a weary voice.

The whiteboard on the wall where times are written down shows it has been forty-five minutes

“I am calling it. Does anyone have any objections? Please speak up.”

No one objects. We clearly lost the battle. We can do only that much. We are not gods.

“Everyone, before we leave the care of this patient, let’s take a moment to pause and honor the person that we have cared for. It is a person who had family and friends and was important to them. Let’s take a moment to recognize that now and honor the life with a moment of silence.”

We all bow our heads. I swallow to release a lump that formed in my throat and the room comes back to life. People rip the plastic gowns off, throw the gloves away, and sanitize their hands.

I come closer to the gurney with the body. One arm is hanging down, the hand tinged grayish and purple and the forearm is covered with thin parallel scars. There is a detailed tattoo on the shoulder of a baby’s face with plump cheeks and fine hair. Under the face is a large cross with two dates just a few months apart. A young guy by my side looks at it, too.

“I don’t want to know that story,” he says. “These freaking drug addicts. So much effort to save the wasted life.”

My chest feels too deflated to talk so I don’t say anything back.

I do believe that every person alive carries a gem hidden deep inside them. This gem may be big or small and may be covered with thick layers of disapproval, shame, negligence, and addictions, but it is always there, pure, and beautiful. Maybe, the whole purpose of every life is to uncover that gem and make it visible.

It is already past seven, and the night shift person is here. I hand over the pager with the taped-together holster and the elevator key. My day is over.

The locker room is empty, and I can hear the fluorescent lights buzzing quietly. I throw the sweaty scrubs in the laundry bin and change into my street clothes. Outside is dark and drizzly with no moon and no stars. The glow of the neon entry sign and flashing ambulance lights reflect upon the wet pavement. Of course, I don’t have an umbrella. I live in Seattle, after all. Only the new people use umbrellas here. The rest of us are proudly pretending to be waterproof.

I linger for a few seconds before walking to the parking garage. I shrug off a few heavy raindrops that seep under my collar onto my warm skin. I stretch my neck to look up at the top of the building, where a flag hangs down, wet and heavy. I get a bit dizzy when looking up that high, and I suddenly feel my shoulders are tight and tired, and my legs are tired and sore. For a moment, I acutely feel I am not young anymore.

What am I trying to see there? An angel or a soul, making its final rounds before the departure into the unknown? A soul that shrugged off all the dust of a human life not lived well and takes with it the hidden gem that never got revealed.

I feel pressure and tenderness from behind my eyes. Am I about to cry? With so many years at the hospital, why do I still feel like crying after witnessing death?

The drizzle has turned to rain, soaking my hair and numbing my cheeks, taking over all of my thoughts and feelings. A growl in my stomach brings me back, and I realize I haven’t eaten since breakfast. The day is over and it’s time to go home.