My First Death.

Rule #1 of a medical student on a surgical rotation: Never walk into an OR without first meeting the patient.

Today, I broke that rule. And it's probably the one reason I'll be able to sleep tonight. If I'm able to sleep tonight.

I was assisting my surgery preceptor with an elective surgery for a man with end-stage renal disease who needed better vascular access for dialysis. Was it the most fascinating thing in the world? No. Was it cool to see named vessels in a real, live person? Definitely. But then the phone in the OR rang, alerting us to an emergent case of a women presenting to the ED with a ruptured abdominal aortic aneurysm. See also: the scariest thing in all of medicine, wherein people bleed to death into their abdomens and/or their pericardial sacs.

"Go see that, Melissa!" my preceptor said. "That'll be definitely more interesting."

I didn't want to go. I knew I wouldn't be useful. I knew I'd be overwhelmed. I knew I wouldn't have met the patient before she was intubated and put under general anesthesia. I figured, however, that any other medical student would have loved the opportunity to observe the surgical management of a ruptured "triple A." I figured that I'd be an idiot for passing it up.

So I went. I gently opened the OR door -- and then *BAM* was blown away by the sights. There were 30 people, scrambling all over. Blood everywhere. Lots of monitors beeping. Surgeons calling out orders, calling for equipment and instruments. Organized chaos, if you will.

I slid up against the side of the wall. This was not my world. I didn't want to engage.

After a few minutes, the EKG alarm started going berserk. I recognized the pattern from televsion. The patient was in SVT. In my head, I silently reminded myself what drug to give her. Immediately thereafter, I heard the anesthesiologist announce that he was giving the patient this very drug. But the alarm continued to sound -- crazy fast beats, all over the place. Then, they slowed.

"She has no carotid pulse!" someone called out.
"That's your indication for ACLS."
"Beginning chest compressions now..."

I watched in horror. The surgeons continued to frantically attempt to stop the gushing blood from her aorta while the anesthesiologist rhythmically moved up and down behind the blue curtain separating her abdomen from the rest of her. I could only imagine how much force was being generated into her chest.

"This is useless - when do we call it?"
"Another 2 minutes..."

Two minutes later, they stopped. I didn't hear anyone call the time of death. I just left.

I felt numb. Kind-of like when I suctioned a demised embryo. I didn't feel anything, except the feeling that I "should" be feeling something.

I left the room. I saw my preceptor in the hallway a few minutes later. He started teaching me about the statistics of AAA ruptures and cardiac arrests and fatalities, and how the present situation had a 90% chance of occuring. I was silent. I realized that this perhaps projected disinterest.

"I'm sorry for being quiet. I've never seen anyone die before."

He asked me if I were ok, was truly kind and supportive. And I truly was ok.

Until an hour later, when I learned that this woman presented to the ED while her husband was being evaluated elsewhere in the hospital by a neurosurgeon for his own brain aneurysm.

When he came out of his appointment, after dealing with his own very scary reality, he would receive news that his wife was dead -- the very last thing he could ever have expected.

Then, I felt something. I felt a cold sweat break out, a deep ache in my stomach. I imagined what that might be like, and I felt like vomiting. I felt like crawling up into a little ball and bawling.

But instead, I cried just where I was.