It wasn’t all that long ago when an ambulance pulled into the bay with a code in progress. The patient was apneic and in asystole on the scene but EMS personnel were providing full life support measures. This scenario is really rather common, however this time the patient was unusual; it was a baby, only a few weeks old. He had been fine one minute and then had just …stopped. The usual things we consider in the death of child, physical violence, drugs, etc were not this case. This case was every parents’ nightmare scenario – their beautiful healthy baby, without any warning, just stopped breathing.
The child was whisked into a trauma bay and after running several cycles of the life support protocol a cardiac rhythm was obtained. The mother, who had come with the ambulance was hysterical. The father drove the car and arrived minutes later looking utterly hopeless. Return of circulation was of little comfort to them based on how they looked as their child was transported to the PICU. However the code itself was all very textbook. We didn’t know it at the time, but the boy would not survive.
Despite this incredible tragedy the department kept moving because it must. Ironically enough I diagnosed a teenager with a 17 week pregnancy minutes later. The ED doc and the pediatric attending discussed the evidence of using bicarb with epinephrine in infants. More patients checked in with various non-emergent ailments, unaware of why they were kept waiting so long. And I felt nothing. My mind knew this was tragic but I did not feel sad. But I also knew I should feel sad which then made me question my lack of emotional response.
As I related this story and these thoughts to some fellow residents days later a rather extraordinary thing happened. I began hearing similar stories from them. One broke down rather inexplicably but then related how she’d been involved in a similar pediatric code in the ED. It had been months earlier and she’d felt nothing at the time too. My story had made it all come back to her, however this time with emotions. Another resident, one of the most stoic in our program, teared up as he recalled participating in a pediatric withdrawal of care. A third shared how she had recently delivered a late pre-term baby after in intra-uterine fetal demise. She felt nothing at the time and still had no particular emotional response to that delivery.
Physicians receive very little training in how to deal with the difficult feelings around death and I imagine it’s the same for other providers, nurses, and first responders. One thing that nobody ever said to me, and it took a long time to realize, is that it’s okay to feel nothing. Based on my colleagues’ responses most of us will have experiences that should arouse emotion but don’t. Unfortunately medical training does not typically push us to share these experiences and we are left feeling isolated and guilty. Many of us will bear witness to terrible tragedy and not feeling doesn’t mean not caring. It may simply be that we are not in the right headspace to process those feelings but will at a later time. It may be that burying an emotional response is a deep defense mechanism to protect ourselves. It may be that a particular tragic event, for whatever reason, will just never provoke an emotional response. Regardless of the reason, if you are in the healthcare profession you will at times have experiences that should provoke emotion, but only leave you feeling nothing. And that’s okay.
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