| In the Balance |

Great to See You Again

“Last time we met, you were called John”


edic 9 reporting,” EMS squawked over the radio. “We’re coming in with male patient, approximately 60–65 years old, found in cardiac arrest. He’s been down for about 30 minutes by now, we’ve been doing CPR, gave him epi and amiodarone, we shocked him. Continuing CPR, ETA is about 15 minutes.”

Around the ER the acute care team sighed.

You don’t want to think it, you know it sounds bad, but you’ve seen it so many times: patient will come in, they’ve been down for a while, we’ll try some more CPR, try everything we can, but eventually we’ll have to pronounce him dead; another one lost. So many times these patients are older, there are probably comorbidities, and when they’ve been down for a while… sometimes it’s just not reversible. We’re just doctors, not miracle workers. We can’t fix everything.

But we don’t predict the future, and of course we have to try. In any case, we were ready. EMS brought the patient in, we hooked him up. No heart rhythm.

“Continue CPR,” I called out.

The team worked together, everyone knows their job. A tech started CPR.

“Nadia, one amp epinephrine.” Nadia drew up a syringe and injected it. Jason rolled up with a portable ultrasound machine, I performed a quick echo.

“Pulse check,” Nadia called.

Lo and behold, the heart was beating.

Here we go again, I thought. The guy has been down for over 30 minutes, there’s probably no brain function. What kind of meaningful recovery can he have?

I looked at the patient. He’d been found by a passerby, lying facedown in a park. Probably out for a walk. They’d brought him in without ID, we had no information on him. He was entered into the system as John Doe. Still, he’s a precious human life. Somewhere, he’s special to someone.

We kept working on him.

Protocol in these cases is to apply ice packs over the patient’s body. Cooling the patient lowers the body temperature, which has been shown to preserve function. We did blood work, performed an EKG, inserted a central IV line. Remarkably, John Doe seemed stable. A CAT scan of the head showed no bleeding.

After an hour, we stabilized him and sent him up to the ICU.

It was an anticlimactic moment. We got a pulse back, which is great. But he needed a miracle. He wasn’t moving or even breathing on his own. We didn’t know what the future held, if he’d have a meaningful recovery. We didn’t know if he’d regain any function.

We didn’t know the past either, what happened to him, why he had gone into cardiac arrest. We didn’t even know his name.

Everything about him was unknown.

But that’s a day in the life at the ER. You just keep moving. There are other patients to treat.

Like the guy who came in the next day straight from a wedding, still in a suit and tie, complaining that he couldn’t hear. The music had been too loud, he didn’t have earplugs, so he’d stuffed some challah into his ears.

Or the guy who came in a week later with his hand jammed in an industrial mixer. Yes, the mixer came in with him. First time I have ever needed to call the hospital maintenance crew to assist in treatment.

Or the guy who came in several months later with a laceration — he cut his hand with a steak knife while eating a special anniversary dinner with his wife. He was tall, well-groomed, apologetic for not being careful enough and creating all this fuss and bother. I stitched up the wound — it wasn’t that bad — and then I went to update his chart.

Funny, it said I treated this guy nine months ago. I looked over at him again. Weird, I didn’t remember him. Then again, I do see a lot of people every day.

I clicked the chart open. It was John Doe.

My mouth fell open as I skimmed his history. He was admitted into the ICU, they cooled him. After two days, they began warming him again. He started moving and following simple commands. His coronary arteries were clear; the assumption was that he had gone into dysrhythmia, then cardiac arrest. They put in a pacemaker and discharged him to rehab — weak, but neurologically intact.

He’d spent two months in rehab and then returned home to his wife and teenage daughter. He was back at work. He was grilling steaks again. He’d lived to celebrate his 40th anniversary.

I went back into the room.

“Hey, John,” I said.

He looked puzzled. “Milton,” he corrected me.

I folded my arms, smiling. “Last time we met, you were called John.”

Now he gave me an odd look. “I’m sorry,” he said, “I don’t believe we’ve met before.”

I couldn’t stop smiling. “Yes, we did. We met last year in August. Right here in the ER.” I saw understanding lighting up his eyes. “Last time we met I didn’t know your name. We thought it was hopeless. We thought we would never get you back. One minute.” I poked my head out through the curtain. “Nadia? Can you come in here?” I waited while she stepped inside. “Meet John Doe.”

John/Milton was crying, his wife was crying, Nadia was crying. Fine, maybe even I was crying a little.

You see so much pain, you can get so jaded. You forget that what you’re doing makes a difference. You forget that miracles do happen.

I stretched out my hand, he shook it. His grip was firm. “It’s a pleasure to see you again,” I said.

Originally featured in Mishpacha, Issue 763. All names and identifying details have been changed. Patient profiles may be based on composite cases.


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Tagged: In the Balance