Loice A. Swisher, M.D.

Dept of Emergency Medicine

Medical College of Pennsylvania
Philadelphia, PA 19128

It was six days before Christmas. All I had to do was turn the Emergency Department over to the incoming attending and I would be free for two days of shopping and wrapping presents. Suddenly, the call came in. Medics would be arriving in five minutes with a code — a three month old. In those precious minutes, we readied the cardiac room for an infant resuscitation.

Everyone stared at the door in anticipation as the sirens drew closer and flashing lights appeared in the window. Bursting through the doors, a medic carried in his arms a beautiful lifeless baby. Amidst the ensuing flurry of activity, every effort was made to revive the child. But, despite our efforts, his young life was gone. The air of hurt hung in the room, but our work was not yet done. The family had to be told.

Hearing the agonizing news, the father let out a tortured cry. Running into the examination room he scooped his child tightly in his arms and from his pained lips came the question: WHY…??? However, there were no answers to his question. When I arrived home, I took my four month old in my arms and shed silent tears.

The code, a cardiopulmonary arrest, is a relatively common occurrence. Every student at some point during medical school will be there — in the room — watching, helping and learning. Through internship and residency each new doctor will have increasing responsibilities thrust upon him or her. First, it will be running the code, then notifying the family, and finally overseeing other less experienced physicians. The emphasis in training is to learn how to do it. Procedures are practiced and algorithms are drilled into each mind. But, the emotions, the fears and tears, brought about by being involved in these situations are not often openly discussed.

There are the general anxieties that most students feel at some point. Will I know what I’m supposed to do? Could I have done something to prevent this? What should I say to the family? How will they react? What if I don’t know the answers to their questions? What if I cry? Then there are intense feelings which may come about in particular situations. The most common difficulties are when the events hit close to home. It may be the elderly woman dying of an acute heart attack who seems so much like a grandmother. It may be the teenager shot in the chest who is the same age as a brother. Or it may be the child who seems so much like your own.

All medical students will face encounters with death, and each is a personal and unsettling event which does not become any easier through repetition. The best we as faculty can do is to encourage students to explore their own feelings, and to do so early in their career. I applaud the efforts of Dr. June Penney at Dalhousie University to approach this issue head on, and to do so in a structured and supportive manner. Introduction to the cadaver is a critical and logical beginning of this journey which then continues through the autopsy, the first code, the first time pronouncing someone dead, and the first time talking with the family. Learning early in one’s medical career to openly discuss these emotionally charged issues within an established and supportive network of peers is an important lesson, and one which is valued by front line physicians who daily work at the threshold of life.

Those who have lost an infant are never, as it were, without an infant child. Other children grow up to manhood and womanhood, and suffer all the changes of mortality. This one alone is rendered an immortal child. Death has arrested it with kindly harshness, and blessed it into an eternal image of youth and innocence.
James Henry Hunt