By Richard A. Giovane, MD
“Code Blue, 7th Floor, North,” blared the overhead alarm as I was running my plans for each patient with my intern. It was the middle of November, I was a third-year medical student in an internal medicine clerkship; the days were long, the patients were complicated, and the intimidation of the medicine floors was in full swing. Naturally, I still didn’t know what I was doing, but truly, who does during their third year of medical school? As the code was called, I speed walked to the 7th floor. I was tired, I had a tough attending that week, my UWorld questions were not going as well as I hoped, and I was homesick. Although this particular day began the same as any other, nothing quite prepared me for what was about to happen. I made my way to the room, and my intern ran through code blue procedures: “Do you remember your algorithms? Have you have done chest compressions before? You know how many Joules to use when shocking?” This was my first time going to a code.
With a sinking feeling, I realized the code had been called on a patient I was caring for and had gotten to know over the three weeks I was on service. She had a pleasant family and called me “sugar” every morning when I went to see her. I had examined her just 30 minutes prior to the alarm. As I was reflecting on this, large blue gloves were placed on my hands and I was told “start chest compressions!” I had lost patients before, some I knew, others I had known only at that moment, but this was different. We had bonded, but now, death was knocking on her door. After several rounds of CPR, shocking her and giving epinephrine, it was decided to call it and she died. I removed my tie, now soaked in ultrasound gel. I sat with my intern while he broke the news to the family, and tears were shed as he told them, “We did everything we could.” Before they left, her daughter paused to tell me, “She liked you best, sugar”.
Encounters like this make me reflect on the reality of losing a patient. As we are buried in medical school textbooks and stressing about tests, we seldom realize that although we are gaining knowledge to help people, sometimes even our best won’t cheat death. Despite this, we still try, because it helps to ease the blow when a patient dies. We can further distance ourselves from the situation by putting up a defense; we can tell ourselves they were the patient and we were the doctor. But what do we do when they aren’t justa patient?
I remember where I was when I got the phone call. It was my second year of medical school, and I had a crazy week ahead of me. Our week was bookended in challenging midterms: pathology on Monday and microbiology on Friday. In between these tests was an OSCE exam, making it truly a difficult week for any medical student. I remember walking out of the first pathology exam feeling good. Like every student in my year, we put the most emphasis on pathology and neglected microbiology, only to cram as much as we could before the test. With no lectures that week, I planned to study microbiology diligently between Tuesday and Friday morning. After lunch on Wednesday, I checked my email and a chill ran up my spine when I saw a message from brother that read, “Family Emergency: CALL HOME RIGHT AWAY!”
On the phone, my brother told me that my maternal grandfather had died of a heart attack. No words can describe my disbelief. I was alone, hundreds of miles away from my family during the loss of someone with whom I was very close. After I got off the phone with my brother, I headed to the docks that overlook the Caribbean Sea near campus. It was sunset and I couldn’t fight back the tears. As I cried, I still couldn’t believe that my grandfather, my Nonno (Italian for grandfather), had passed away. He was my hero, my Batman! I reflected on it for over an hour and just asked myself “why?” I didn’t understand his passing; he was in good health. I didn’t understand the timing of his death; I hadn’t grown up to make him proud. I didn’t understand why he left so early; I didn’t get the chance to say goodbye. With many tears and long reflection, I decided to stay in Grenada and miss his funeral. He always told me, “Go to school, get smart and do good things,” and so I justified that he would understand why I stayed. I still regret not going.
How do we distance ourselves from death when it takes one of our own? There is no easy answer. With a patient, we say, “I was their doctor first,” to minimize the pain or sadness we might feel when they pass. With our loved ones, this reasoning does not work. It is said that time heals all wounds, but the scars remain as reminders of our emotional trauma.
I still have the tie I wore to the code that day. I took it with me when I moved for residency and have it hanging in my closet. I call it my sugar tie. I will never wear it, as the faded blue hue of the tie still shows the stains of the gel used in the code.
I still remember the last time I saw my Nonno, just before I left for my second year of medical school. He was happy and encouraged me to “take it easy with school,” as we played Italian cards. He even gave me a pack of his old cards to play with my friends on the island. I still carry a pack of them with me in my backpack, every single day, just in case.
My Nonno on his 81stBirthday:
Honesty was his ideal
Work was his living
His family was his heart
About the author: Richard Giovane is a current PGY-3 in Family Medicine at the University of Alabama, at Tuscaloosa [Roll Tide!]. He was born in Canada but has an Italian background, and yes, he does talk with his hands a lot and has difficulty grasping the concept of the volume of his voice! He enjoys reading, writing, playing video games, and has a strong passion for medical education. He is currently the Senior Editor for Step 1 Qmax and has served as an author for several First Aid books.