Tyler Murray is an Internal Medicine Resident (R1) at the University of British Columbia who graduated from medical school at the University of Toronto in 2017
Fortunately, I found myself starting medical school unacquainted with death. I had only been to a single funeral, all four of my grandparents were still alive, and my entire extended family was relatively free from chronic disease.
Our first exposure to death in medical school was in the anatomy lab. At the end of the first week, we were brought down to the morgue and introduced to our cadavers. A small card with a simple line about who they were hung at the foot of the table: "54y male. Cause of death: lymphoma.” Over the next two months, we became intimately familiar with these bodies. Each day, we crossed a new boundary in a process of uncomfortable, progressive desensitization. I wonder now if this was intentional. On the first day, we opened our body’s chest. The next day, we removed the heart; I held the still mass in both hands. Something inside you fundamentally changes when you hold a man’s heart in your hands. By the end of the course, we were all well-versed in anatomy, accustomed to the smell of formaldehyde, and comfortable touching dead bodies — but we had not learned a thing about death.
My first brush with death in medical school was unexpected and traumatic. I was sitting in lecture when I received a text from my close friend. I glanced down at my phone and my heart missed several beats. "You know our friend from back home? She was killed last night in a car accident. I figured you would want to know."
This individual had been a friend and competitor of mine all through school. She had the highest mark in every class, leaving me and the others to squabble over second. We ran on the school track team together. Dedicated and driven, both pursuing medicine, we were very different people — but alike in more ways than not. She was a wonderful, caring person, bright and full of promise. Her death was a tragedy, and frankly… it scared the hell out of me. Bad things weren't supposed to happen to good people. We were invincible. We had to be, in order to succeed in a profession where we dedicated our lives to the care of others. It was not her time to die. Her life was unexpectedly — unfairly — cut short. Her death deeply upset me, and I often think about her long after her death. I write these words now with a heavy heart. You cannot predict which death will be overwhelmingly unbearable, or the extent to which it will impact your life, until it happens. Prepare to be unprepared.
The Point of No Return
The ding of the intercom goes off over head: "Code Blue. Cath Lab. Cardiac surgery STAT.” A middle-aged man had just arrested on the operating table. The interventional cardiologist had punctured the wall of a sclerotic coronary artery. The patient's blood was now pouring into his pericardium, strangling his heart. I strapped on my 30-pound lead vest and pushed open the doors to the operating theatre. A finger was pointed at me and a voice said, "You. On the stool. Start CPR." I felt a whole room of piercing stares boring a hole in my back as I placed my hands on his chest. I started compressions as the physician struggled frantically to plug the hemorrhaging artery. "HARDER." I had to push so much deeper than I expected. That was not the hard part.
The code was run for 52 minutes, and I had my hands on the man’s chest for three-quarters of it. At 20 minutes of asystole, the man's blood pressure was maintained solely by my compressions. This man's life was, quite literally, in my hands. Bright red blood was now spouting out of the disconnected endotracheal tube, which had broken off during my vigorous compressions. I had a vivid image of what this man's lungs looked like — not dissimilar to a kitchen sponge. Who would he be if he woke up? Just ten minutes of cerebral hypoxia is irreversibly damaging. How about 52? My mind raced as I became increasingly uncomfortable and exhausted.
At 52 minutes, the staff physician called off the code. Exasperated and defeated, he walked out of the room silently and disappeared. Presumably to go talk to the family. A nurse patted me on the shoulder and commended my CPR technique. The teams dispersed while the man remained on the OR table alone, violently battered and bloodied. I resumed rounds with my surgeon, and even as I saw the first patient was alive and well, my mind remained in the operating room.
I left the room. I stepped into the hall, took off my scrub cap, and threw it on the floor on the verge of tears. I was exhausted, soaked head to toe in sweat, frustrated, and feeling helpless. It took ten minutes to gather myself and return to the ICU. I tried to approach the cardiac surgeon, but as a man who dealt with death on a daily basis he did not understand my perspective. I had never before performed CPR. Never had I seen someone die in such a traumatic, bloody way. Never had I seen a man die who was not ailing from a terminal chronic disease. Never again would death be an abstract concept; that day, it became real.
Note: The case described in The Point of No Return is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.