Surgery is high stakes. Correction, medicine is high stakes. There are great days, but there are also some terrible days. Some of the most memorable parts of my training were the bad days…days where a patient died, I made a big mistake, had a major complication, or learned something the hard way. I recently had one of those days.
I do endoscopy as part of my surgical practice. Scopes are often considered a more “relaxing”, low stakes kind of procedure comparative to other invasive procedures. Most of the time, this is true. A patient was referred for an elective scope for a diagnosis of anemia and melaena (black colored stools), concerning for possible GI bleed. This is not an uncommon reason for endoscopy, both upper (EGD – esophagogastroduodenoscopy) and lower (colonoscopy). We will call this patient Mr. X. Mr. X had several medical issues (heart, lungs, kidneys), and would generally be considered “unhealthy”. The patient did just fine with the EGD, but halfway through the colonoscopy his blood pressure suddenly tanked to 50s/30s. This is NOT normal. The anesthesia provider stopped sedation, gave fluids and pushed pressors without effect. We terminated the procedure and found that he was now unresponsive and had no palpable pulse. A code blue (a common term for when someone is in cardiopulmonary arrest and needs resuscitation) was called.
This is incredibly uncommon, especially during a routine elective procedure. I hadn’t run a code since residency. It’s amazing how that muscle memory comes back to you. It’s hectic but calm at the same time. There are 15 people in a small room, all talking at once, but still everything that needs to happen, does. The patient received chest compressions, medications and was intubated (had a breathing tube placed). We got his heart restarted in about 10 minutes.
Long story short, even after getting him back, he did not have good odds of recovering because of how many medical issues he had when he came in. Thankfully his family was easily reachable and very understanding. We determined that he would not want any heroic measures and the decision was made to withdraw care. He passed peacefully that day.
A patient death is one of the most impactful things that can happen to you. It can be shocking, traumatic, saddening, devastating, or all of the above. Of course, I had 10 minutes before I had to continue with another patient endoscopy and the rest of my day. And now I was running behind schedule. This is something healthcare workers – doctors, nurses, etc. – have to just “deal with”. There is no time to recover or process. And it is a damn shame. It is something the general public often just can’t comprehend about this career path. Many understand how it feels to have a loved one die, but they don’t understand the feeling of being responsible for it. Survivor’s guilt is real. And it impacts everyone differently. For my fellow medical professionals, I see you. And I hope you have the resources, time, and a collegial atmosphere to support you through experiences like these. A giant thanks to all of you for shouldering these burdens for the sake of what we do.