Klaxons blared in my skull, jarring me violently from my brief respite; instantly I regretted nodding off with the pager so close to my ear. Despite the display’s glowing green backlight, the words themselves were impossible to read, obscured by ordinary 0300 eye-blur and the myopic lens of acute-on-chronic sleep deprivation, but the message came through loud and clear: trauma patient en route to the hospital.

In the emergency department, the team of nurses, paramedics and physicians donned protective equipment, talked idly and teased one another about the quiet shift thus far. The office water-cooler chatter died abruptly as the doors slammed open. In rushed a stretcher bearing a shapeless figure, whisked immediately into the waiting trauma bay. A flurry of activity ensued as each person set to his or her assigned task, starting intravenous lines and placing monitors toward the woman’s head, while at her feet we began shredding clothing and searching for pulses. Yet even an inexperienced third-year medical student could see it wasn’t good —pressures too low, wounds too many.

We did everything we could, but ultimately it was too little, too late. Eventually the order came to halt chest compressions, signaling the end of resuscitative efforts. It was several more seconds before I realized that this was the first time I had ever witnessed someone’s death. The attending trauma surgeon must have recognized the look on my face as he started my way, mouth hanging halfway open as if to speak. But just then a dozen pagers on a dozen hips began to chirp in crazed, chaotic cacophony: rollover accident, two injured, estimated time of arrival…

At the Veterans Affairs hospital months later, I was assigned to care for a salty, middle-aged veteran with terminal cancer. Agonized by constant pain, bones riddled with tumors, his sole remaining pleasure in life seemed to be the daily haranguing of his medical student. After weeks of struggling, I finally managed to win his grudging respect only after discovering that he had taken to hoarding pudding cups in his room. By unspoken accord, I ensured that any wayward desserts found their way into his drawer, and in return, he directed his ire towards others on occasion.

On the penultimate morning of my tenure at the VA, I went to restock the secret stash of sweets only to find the vet’s bed strangely empty. When I asked if the patient was in the restroom, his nurse looked puzzled for a moment before casually responding, “Oh, he died.”

Oh, he died. An offhand quip, but words that sank into me, weighed heavily on my chest; dense as lead, inert as stone. This was neither the time nor the place for contemplation, since there was much work to be done, as always. More importantly, I had a phone call to make, because the responsibility of informing the late vet’s mother fell to me. She had been planning on visiting later in the day. How could I ever tell her this grim news now? Whatever I had to say, it would be heartbreakingly too little, too late.

On a late winter’s morning, the “code” team responded to an emergency in the University Hospital. I followed the feet of the senior resident ahead of me as he flew down the stairs, two steps at a time, while I awkwardly half-stumbled and half-fell behind him. Despite our best efforts, the patient did not survive the resuscitation.

I had just witnessed my second death of the week. As for total number seen as a medical student, I had long ago stopped counting. Somewhere deep down, I thought that I might have felt a slight stirring where my heart once resided, but it passed quickly enough.

One of the attending physicians took notice of me, led me aside, away from the commotion in the area of the now-deceased individual. He threw his arm around my shoulders, gave me the old “You Can’t Save Them All” speech and encouraged me to contact him if I needed to debrief or decompress. It was a great talk, emphatically and admirably delivered, from-the-heart and perfect for the situation.

It was also too little, too late.

Mike Yee can be reached at mayee@engin.umich.edu.

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