Issue link: https://tmcpulse.uberflip.com/i/845136
t m c » p u l s e | j u ly 2 0 1 7 5 we realize. To reset pacemaker: turn it off, turn it on, see if that helps. We continue CPR. Anesthesiology comes and inserts a tube into his throat so we can breathe for him. But it doesn't matter. We never get another shockable rhythm after the first shock, just a flat line. Asystole. More compressions. More epineph- rine. Other meds, too: amiodarone, calcium, magnesium, bicarbonate. We draw quick-resulting labs. We call car- diology for a bedside echocardiogram to look at the heart. It's not moving at all. After 30 minutes, I ask if anyone has any objections to stopping the code. No one does. We pronounce him dead. And just like that, the mayhem ends. The compressions stop. The plastic IV tubes are disconnected and thrown out. The hastily placed endotracheal tube is removed. The alarms are silenced. The defibrillator pads are removed. Pharmacy takes their cart of medica- tions and leaves. The crowd begins to thin. The patient's nurse begins mak- ing the final arrangements before the family arrives. His jaw, which was slightly gaping, is gently closed. His head is laid straight back, eyes looking up. Bloody linens are replaced with fresh ones. The patient is draped in a new gown. Despite his recent ordeal, the patient now radiates a sense of calm. The man's stillness is serene, other- worldly. Impossible for a living being to achieve. The few remaining people in the room use hushed voices. The room feels sacred, somehow. I look at the man again. I think of Homer's line from The Odyssey: "Upon his eyes gathered the mist of death." I perform the death exam. I check his eyelids and see no corneal reflex. Feel no pulse. Hear no breath sounds. It's done. I exit the room. A few feet from the door, a young black woman in cheery pink scrubs is curled up in a ball on a rolling chair near a desk. Her head is in her hands. Her shoulders jerk intermittently. In printed block letters, her ID badge reads MEDICAL VOLUNTEER. I ask if she's OK, and she looks up at me. Her eye shadow is starting to streak down around the corners of her eyes. "I was watching him. I—I called for help. He wasn't breathing. I've never seen ... that ... before." I nod. Words don't come. I stand beside her for a while. After a few minutes, I turn and head back to my call room. Somehow, I feel comforted by her crying. This seems the most appro- priate reaction to the last 30 minutes. I've run a few more codes since this one. It feels, if not routine, certainly easier than the first one. More algorith- mic. But I can't shake the feeling that I shouldn't become too comfortable doing this. I want to always remember that volunteer. She didn't know this patient personally; he wasn't family. But she wept all the same. To me, her tears acknowledged the frailty of it all, the randomness. The callousness of death, the gift that is life. It was inspiring. The day I can't feel the way she does about my patients is the day I need to find a new profession. Benjamin Gold, M.D., is an internal medicine resident at Baylor College of Medicine. Credit: courtesy photo ++ # *+$$$% +"&(+ !%*+ #!'%$ #+ + %$ +#+$$+$ )++Certified #!) + ( %!#* + % ++"#+#(+ We shock. The patient's body tenses suddenly and violently. It's strange to see him move so much. Strange that our mus- cles run on electricity. Strange that to save someone you hook them up to an outlet. We're more machine than we realize.