Louisville Medicine Volume 69, Issue 2 | Page 23




Nine . Level One . Two minutes ,” is announced by the PA system . Two minutes following arrives a man in cardiac arrest , intubated with a penetrating gunshot wound to the chest . With the airway secured , my scalpel finds the chest , the patient ’ s lung palpable under my finger as blood pours from the chest staining my shoes . The surgery resident on the opposite side of the chest finished just before me ; equally blood poured as she placed her chest tube . No pulse palpable . The patient has been down for greater than 20 minutes at this point and further interventions appear futile . After reaching consensus with the resuscitation team , I fold my bloody gloved hands together ; my eyes fixed at the monitor , glancing at the time on the wall . Asystole . No pulse . Through the chaos , a pause , all eyes in the room focused on me . “ Time of Death , 23:59 .”
Suddenly without a beat , a voice cracks from the back of the room , “ Can we take a moment of silence ?”
A moment of silence after an unsuccessful resuscitation has been in place since I started my training at the University of Louisville and is commonplace so far my senior residents can recall . More often than not , it is our chaplain colleagues who are the ones to initiate . If not present , one of our nurse leaders will make the effort to preserve this process .
On a busy shift when the Room 9 Buzzer feels that it is running on repeat , I often found myself irritated at the chaplains for this ritual . I think to myself ; I have other patients to see . I have sick patients out in the main department who need me and who may share the same fate if I don ’ t move faster . Simply , I need to move on . In my mind , I am a manufacturer who needs to keep the lines of production moving , in this case not producing product for distribution but preserving life .
In emergency medicine , unlike most other specialties , when a patient dies , there is often little time for reflection . Often after leaving Room 9 , I either deliver the bad news to family or move on to the next patient . “ Good evening sir , my name is Dr . Kuzel


and I am your ER doctor ,” calm , cool and collected . That patient gets no inkling from me that moments ago another patient was pronounced dead , with their family now grappling with how to manage this tragedy that has enveloped them . In my experience in the ICU , there were at most times , a moment to debrief and collect myself when moving on to the next patient encounter ; not so often the case in the emergency department .
While I was resistant in my early years of training to this “ moment of silence ,” I now embrace the pause . It is that forced necessity of recollection and re-centering to move on in my practice and serve my other patients and their unique needs better . In these silent moments I find myself reflecting on what I could have done differently , the humility of resuscitation , reflecting perhaps on my own mortality , sometimes reflecting over the violence that has ravaged our poor city . Sometimes I pray ; other times I struggle to find the words to tell a family their loved one is gone . More often , I find myself reflecting on the cataclysm of life to death ; I reflect to remember this human being lying on the gurney , imagining life once present in this very room now devoid of it .
The experience of silence for those few precious seconds shared by the surgeons , emergency physicians , nurses , technicians and chaplains connect us , providing us the opportunity to reflect on the heroic measures undertaken in the choreography of resuscitation . It also serves as a reminder of the difference between ourselves and the coroners and anatomist . We operate on the cusps of life and death ; we offer the opportunity for life to continue . Neither stagnant in life nor in death , we offer interventions to bring the blood coursing back to someone on the brink of death .
A moment for silence affords me as a physician a second to focus and remember the humanity of this profession . Too often we find ourselves just cogs in a medical machine moving from one room to another . It is important for us to take this moment of silence to grieve , to collect our thoughts , to cry , to remember why we train so diligently and learn from our shortcomings . We are human and must retain our own humanity lest we fall victim to apathy .
Dr . Kuzel , MBA is the Chief Resident at the University of Louisville School of Medicine Department of Emergency Medicine .
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