Room for a view: I witness

Five-thirty a.m. I answer a stat page to the emergency department. Peering down the long row of curtained gurneys as I enter, I see a steady flow of nurses and physicians going in and out of one in particular. At the end of the gurney, protruding from the curtain, I also see well-muscled calves, feet wearing high-tech running shoes. What has happened is easy to surmise: an early-morning heart attack, followed by cardiac arrest. I am correct. The EKG strips all show ventricular fibrillation, which has already proven resistant to three countershocks and high doses of lidocaine. The amplitude of the fibrillations steadily decreases as, for the next 20 minutes, the drill continues: bretylium, amiodarone, epinephrine, compressions and ventilations. Repeat. The rhythm of the code is continuous and steady, but the rhythm of the heart, it becomes apparent, is now gone forever. Near the end, the man's spouse — unable any longer to stand this waiting, the painted cinderblock walls of the family room closing in, perhaps — enters, accompanied by a nurse. I want to be with him, she proclaims through tears, finding a seat in the corner. I continue to feel for a femoral pulse, but perhaps she, not I, should lay her hand upon this warm body. She watches from the corner. Finally, when there is nothing more to do, nothing more that has not already been done many times, when it becomes clear that all I have left to treat is the body of a man who has died, the code is called. The woman stays with her husband's body, and I go to tell their adolescent children that their father has died. They stop me in the doorway, before I can enter, before I can sit down with them, their eyes and their voices arresting my progress, their eyes and their voices quavering with grief and fear that I know I cannot relieve. I stand at midpoint in the doorway, half in, half out. Words tumble from my mouth, words that pour into the room with the deadly weight of quicksilver, words that will weigh upon them so heavily for the rest of their lives, words that soon trail off into mere vibrations devoid of meaning. I am so sorry. I am so sorry, we did everything we could … They hold each other, dissolving in shared tears of anguish. My words spoken, I feel myself disappear from their consciousness. I wait. Half in, half out of the room and their world, I wait to know what to do next, I wait for some measure of certainty. I go to step back, and then check myself. I cannot and should not leave. I lean forward, and stop. To what end will I enter? I sense above me the doorway bisecting my two limited choices. Neither seems adequate. One step back into the corridor and I will be back in my world, a busy medical world filled with new problems to solve and new patients to treat. One step back and I will be gone forever, an elusive figure who appeared briefly in a doorway. One step forward and I will be in their room, in their world of grief. I can see nothing that my presence in the room would or could add. I wait in this state of limbo, watching their grief, which my gaze does not penetrate. They are alone as I watch. And as I wait I realize that my task is to move neither forward nor back but to pursue a third option: simply to witness this family's suffering, this love for their father and compassion for one another. I can do nothing more, other than write these words, with which I hope have honoured what I witnessed that day in the doorway. Stephen Workman General Internist Halifax, NS

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