There was a very nice medical student in our emergency department (ED) recently. It was her first rotation in the ED and she looked at the tracking board, the ambulances, the activity, and said that it seemed like "controlled chaos," and made her (quite reasonably) a little uncomfortable at first. A few days later she had settled in nicely and was learning and engaging quite well.
I have often thought about how odd that chaos is. A place where the patient confused after a seizure stands up and urinates in the sink ... if not on the staff. A place where the aged and demented lie on stretchers crying out in fear and anxiety, and where their cries are simply the background soundtrack of the place, with a track of someone vomiting recorded over their distress.
It is a place where a naked, drunk man can pull out his IV tubing and walk across the place trailing blood and leaving bloody footsteps like some horrible crime-scene until he is redirected to his room. It is the place where a young woman with nagging symptoms finds, within a 2-hour visit, that her body aches were really due to widely metastatic cancer, and that she will go from normal life plans to hospice within the week.
I was at the bedside recently when a man died an expected death from a chronic illness, his weeping daughter devotedly holding his hand till the end, as his breathing stopped and his last heartbeat trailed and faded across the monitor.
The thing is, I don't remember his name. But it wasn't that long ago. I remember his face and hers. I remember his diagnosis. I remember the nurse who was with me. I just don't know his name.
In the past 2 months I have seen several cardiac arrests come through. I don't remember their names either. I used to feel a little bad about that. But not anymore.
The thing is, I just can't absorb all of that. The job, always emotionally taxing, keeps getting harder. The people are sicker, the resources fewer, the support rarer.
I think about people seeing the dead. How many people see someone die, or see someone who is dead, on a yearly basis? My dad was a pastor and I grew up in West Virginia. I had a large extended family. When my grandfather Leap died, we were awakened by a call from my grandmother and walked up the road to their house, and stood at the bedside where he lay. (It was so unlike the ED. No tubes or monitors -- only the quiet of his bedroom.)
Funerals were normal for me. I saw a lot of dead people and maybe I was prepared for this career from the outset.
Most people just don't see the dead these days unless they live in places of famine or war. Or in pandemic times, when the dead also accumulated (but were seen dead mostly by those in hospitals).
If the average person saw someone die on the way to work, they would call in and possibly see their therapist. Their friends and co-workers would understand. And I get it. It isn't part of their daily tapestry. If they saw a terrorist event or major car crash or fire, with many bodies, they might reasonably be told they have post-traumatic stress disorder.
We in EMS, law enforcement, fire, the ED, the hospital floor, the intensive care unit -- we touch the dead. We try to resuscitate the dead. We pronounce the dead. We tell the families. We then chart the brief story of the dead as we encountered them. We then move immediately to the next person, with cold, or cough, or addiction, or sepsis, or suicidal thoughts. And along the way we make sure we meet our time-stamps and metrics, and that we have documented enough for billing.
We then go home and find ourselves powerless to describe it all.
Little wonder we forget their names, day after week after month after year of the dead, lined up in our memories as we work, ever on the bleeding edge of living and dying.
What a strange world it is.
Edwin Leap, MD, is an emergency physician who blogs at , and is the author of and . You can read more of his writing on his Substack column, , where a originally appeared.