White Night

First night of CCU overnight call.

It is my first time running a code.

The thing they teach you about CPR from the very beginning is that the patient--breathless, pulseless--is already dead before you begin. That nothing you do can make things worse.

It is a training-wheels kind of code. He has already gone through four codes in the span of six hours. My senior suggests I run the next one, because we already know at that point that he will likely not survive the night.

I call the two-minute pulse checks, hesitate on which orders to give... but in the end, it is medically futile to continue.

This is the second death exam I have to perform in my career. It struck me even that first time how vulnerable you are in the end. Naked, covered by a single gown or bedsheet, no jewelry, no material possessions, nothing.

But at least that first one had a family. I still remember his parents, his sister, the way his mother wept when they agreed to withdraw care. After the exam was complete, they entered the room, the curtains were drawn, and they were given the privacy of those final moments.

The thing that continues to gnaw at me is the loneliness of the man who has passed tonight. Previous notes document him stating that he has no social support, his family lives in another state, and he declined to provide any emergency contacts. There was one phone number listed in the chart. We called multiple times throughout the night, with no answer.

I think of my parents, my brother, my person, my friends from elementary school through residency. The man and I are separated by less than two decades. How do you get to the point where you have nobody?

I know the medical pieces to that story. Drug addiction, its wreckage on the body, untreated mental illness. I wonder if his parents are alive, or if he had a brother or sister. Perhaps they are sleeping in their beds at this hour, unaware that he has just passed.

Or perhaps, they didn't even know he had still been alive.