"The Patient is the one with the Disease"

We get used to sadness and death in the ER. Most of the time I detach myself so I can keep coming back. Like the book The House of God says, "The patient is the one with the disease." That basically means don't get too emotionally involved. Sometimes, though, the stories of the day are too much. Here are 4 sad ones from a recent shift.

1) An 86 year old female comes in altered from her nursing home. Yes, most nursing home patients live with altered mental status, but this was different. I won't get into the details, but basically she was raped and abused. Her body was mangled and she had a large subdural (collection of blood in the brain). She didn't have a DNR...but was I really supposed to code this poor lady full throttle?

2) A 43 year old female was brought in by air ambulance in full traumatic arrest. She lived on a lake. It was a cold and rainy night. Her car broke down on the bridge. She then slipped off the bridge, and was hanging on for her life for 15 minutes before help arrived. When help was near, her muscles gave out and she fell. She hit rocks then slid into the water. She stayed afloat for 30 minutes. It was too far down and too dangerous for anyone to try to get her by foot. By the time the helicopter got there, it was too late. She drowned. But because it was a cold night her core temp was 27 degrees Celsius. So we had to code her until she was warm enough to be pronounced dead.

3) Another elderly abuse case. A sweet old lady who had her facial bones punched out. Whenever an elderly person is being pushed in by EMS with the police surrounding them...it's never good.

4) We were told an asthma patient in full respiratory arrest was coming in. The patient was a 33 year old female. She was at home with her 10 year old daughter when she went into respiratory distress. Her daughter called 911. No one else was at the house, so EMS had to take the daughter in the ambulance with them. En route, the mom lost her pulse and respiratory drive. EMS had to start CPR and intubate the mom in front of the child. EMS told us that the child had NO other family. Not an aunt, not a grandparent, just the two of them. We coded her for an hour and a half....but we couldn't get her back. I haven't seen the autopsy report yet, but it had to be a massive pulmonary embolism. Out of all them...this was the hardest one to say those nasty 3 words..."Time of Death."

-ER Doc