Obsidian

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The pager goes off… trauma activation. SICU and I’m on call. I make my way to the ED. My fellow resident is there, doing the lateral canthotomy, ET tube’s in. It’s bad — auto vs. pedestrian — and our patient appears to be a young, healthy guy. This incident, for him, will be life-changing at best. Bed’s dropped, to the OR with neurosurgery. I’ve still got some other stuff to figure out before rounds, complex signouts (what did that echo show on the rollover truck accident r/o BCI guy again?) — the pace of life in the emergency department rolls on like a treadmill. Seconds before rounds start they come out from the OR, brief transfer of care.

“Yeah, partially decompressed … it’s not survivable …”

“… he got a lot of pressors and blood products – gotta go, there is a critical child in another OR I need to help…”

Rounds start, and the trauma surgeon’s gaze pierces me. “How much blood? What meds did he get in the OR? Why don’t you know this?” The attending and the rest of the surgery department stare at me. The rest of rounds don’t go better. Then I walk back to the room where my young patient lies. Now she’s there. His mother.

“So this is the worst moment of your life,” I say.

I take her in my arms. We’re crying. Soon, I call the consult.

“Is she ready?”

“Ready? How could she be ready?” I ask. I think she is ready, though.

The palliative care attending feels like my Aslan, yet my atheism is only growing stronger.

“He was doing so well, off drugs, going to school. Now this …”

She touches his hair; her tears drop on his face. Yet she’s brave. She’s ready. I deflate the cuff and pull the tube. He takes his last breath while his mother’s hands cradle his face. His eyes turn from that dark liquid color of life to the final obsidian, solid out of the fire.

I see and feel that moment.

She kisses him for the last time; she’s crying, smiling, caressing. I have to leave – now shattered glass barely held together. And then I’m crouched on the floor of the bathroom, holding my knees, bawling, bawling.

I haven’t cried like this in years. But sometimes as a doctor, you have to.

Bart Paull, MD

Bart Paull, MD

Denver Health Class of 2017, Denver, CO
Bart Paull, MD

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