Dying of a Broken Heart
In my years of nursing I have witnessed the extremes in human behavior and emotions. I have been moved beyond words, angered at the behavior suited more for animals than humans, and I have seen death. So much death.
What I have learned from you is we all are on the same road. We will all bury parents, siblings, and the most unfortunate is the children that also need to be in the ground. Those are the cases that just never leave. I have seen a person die from a broken heart. Literally.
The boy we had was 14. He was a Mexican descendant, second generation in this country. Yes, he had drifted into the world of drugs, gangs, and it was those choices was the demise he suffered. A gun was fired point blank in the back of his head. The only reason he even made it to us, was the fire station that held a medical rig that was just across the way from where it all happened. A 14 year old heart isn’t that hard to get going again. But a brain that has had damage from a high caliber burst, is terminal.
His father was in his 70′s. They were a very large family, with at least four by my rough count that were even younger than my patient. The scene was all too familiar. The screams when they see their child. The prayers that don’t seem to make it out of the room, and the look of utter disbelief at the child that dabbled in a gangsters world and was swirled into an abyss of evil. These cases are so hard to work. It is hours of paperwork, phone calls, and picking up the pieces of the family that exsanguinated tears and hurt. It never leaves my memory.
When the father complained of chest pain, we did put him on a bed and ran an EKG. What we could see, was he was not having an active heart attack at that moment. We see pain so often, that we discharged him, and told him to follow up with his primary care doctor. We did not draw labs, and that was in hindsight the mis- step that was the doctor’s decision. I will say that I also had no trouble with the plan. It just wasn’t as cut and dry as it seems.
Finally, after his last rites were performed in Spanish by their Priest, the last one to leave his side was his parents. All machines were quiet, and the look of death started to move in. By law, I couldn’t leave the room, but I did stand outside the curtain. They deserved to say good bye in private. To be completely honest, I just couldn’t take much more.
I watched the older couple with young kids hold hands as much to hold each other up as for comfort as they left. Their walk was slow with great effort needed to make it to the car. The father was machismo, yet he cried openly and loud. We could hear them long after the door slid shut. I was so glad to leave that night. I couldn’t sleep. Closing my eyes brought their cries, and pleas in my ears. I finally just got up and paced. I did this until it was once again time to go to work. I was nauseated with fatigue. This was one of the moments I began to think it was time I leave trauma. If I had only known what the new day would bring.
Almost exactly 24 hours later, we got the call that they were bringing in a full cardiac arrest. He had been “down” for an unknown amount of time, and every algorithm they tried had no success. The team gathered around and waited. We were quiet compared to usual, glad that the patient wasn’t a teenager. But it was worse. It was the father who had the chest pains after seeing his dying son.
“Sorry guys, this is rough.” The paramedic had brought us the kid just one day earlier. We worked the code, but it was to no avail. He died in the same room, probably the same gurney, as his son had. It was like that movie where the day just repeats itself over and over.
The same family, the same Priest, and the same crew telling them that yet another member of their family had passed away. Where is the good in this? Where is the fairness to this family from a little village in Mexico who had come to the US for a chance at a better life? Not two deaths in 24 hours.
But then we just don’t get to choose these things. If we could, my mom and sister and brother would still be alive. I would be able to sleep without waking up with screams in my head and tears on my pillow. And yet, even in my private hell, I was the luckiest person in the world compared to them.
About a month ago I saw the wife and the older children at the store. I saw them but they looked right through me. That is how it is. When I taught trauma, I would end every class in this way. “I promise you that the patients family will not remember your name. They will not remember what you look like. But I promise what they absolutely will remember is if you were kind.” I hope that is one thing they had. I hope they knew I cared, and I was sad for them.
I still hear the screams, I still pace much of my nights, and I remember the boy whose father died of a broken heart. I hope I was kind.