Saturday, September 25, 2010

Life, Death, and Renewal

A sense of foreboding gripped me as I entered the department. The aides were pushing a morgue stretcher away, leaving sharp intakes of breath and a muffled cry. Three nurses huddled around the triage desk, one nurse was visibly upset.

Outside the trauma room stood two burly policemen. The aftermath of a trauma resuscitation greeted me: the blood-splattered floor was strewn with discarded clothes, a used stylet, wadded gauze, and the blue overwraps from the instrument trays.

The night nurse looked shell-shocked. On Bed A, an unconscious male patient lay in a tangle of wires and tubes. The ventilator hummed and the monitors bleeped. Endotracheal tube to the ventilator, sinus rhythm on the monitor, an arterial line, two large-bore IV lines, a urinary catheter, right chest tube, right leg splint, dried blood on bandaged head, and his left hand cuffed to the side rails.

"Here's our 20 year-old trauma patient... this..." the night nurse bit her lip to stifle an expletive. "This person just murdered his girlfriend, her two children and her grandma. Shot them point-blank. He jumped four stories off the roof after he was chased by the police. All this because she tried to leave him after a night of beatings. That was the youngest child we just sent to the morgue. " Her voice broke and we both shuddered.

We stood at the bedside and shared each other's anger. The thought of the carnage this man left behind made me recoil in disgust. I felt a need to cry; bile rose up in my throat. Even in repose, this man's face looked so evil, almost satanic. Despite all the repulsion I felt, I had no choice; I had to take care of this patient. My training and my ethical responsibility will ensure that I give this patient the best of care, no matter what.

No matter what… it was the mantra that I kept repeating to myself that day. I had never had a problem with being non-judgmental, but that day, the case touched me. Like everyone, my heart bled for the innocent ones who lost their lives.

The night nurse struggled to finish the report. She was rambling, obviously wanting to simply put the ugliness behind her. I could only pat her back. "He's pending the CAT scan results. His pupils are fixed and dilated; he's unresponsive to any stimuli, no corneal reflexes, and he's posturing." This patient is as good as dead, I thought. The machines keep him alive.

As if on cue, the physician strode over. "He's got a huge subarachnoid bleed. No surgery for him. We're starting brain death protocol on him... and surprise! The cops just found his organ donor card."

Somehow, my anger simmered away. I clutched at one straw of sanity... in one rational moment, this man has willed his organs so that in his death, others could live. The organ donor card tells me that at one point in his life, this man cared enough. A little too late. Why couldn't he be as generous in life?

Then I reminded myself that in his death, he would be lending a gift to someone else. Would his gift of life a renewal for his soul? I doubt it will be, but a gift is a gift, and somewhere, somebody else will live.