Life Matters...Even in Death

A moment of silence.

Taking a moment in the hustle and bustle of emergency medicine is a rarity. As medical providers, we often get caught up in the rigmarole of a fast-paced emergency department, or in my case, the fast pace of a high-volume, high-acuity, inner-city 911 ambulance service. 

But sometimes, taking that extra moment can change the way we and those with whom we interact view the world.

"Is he gonna make it? Is he gonna make it?" I recall a sobbing wife shouting at me as I stood in the poorly lit living room of a quaint blue house in East Atlanta holding a bag of saline behind the paramedic leading a team of rescuers. I was witnessing my first cardiac arrest as a student on an ambulance my first summer in EMS. At the conclusion of the resuscitation attempt, we walked out the front door and through a vibrant green lawn sprinkled with red and yellow flowers, carrying our used equipment to the ambulance. I sat quietly in the back of the ambulance while the paramedic finished his paperwork. 

We left a forty-five year-old male on the floor of his living room and a widow kneeling in her kitchen, grieving the sudden loss of her best friend, soul mate and husband. The paramedic turned to me and asked if I had any questions. "We just leave him there," I said, "and continue on with our day?"

That summer, as a recent high school graduate I saw more death than my immature mind could comprehend. I was a member of a unique summer internship program at the level one trauma center in Atlanta, GA, shadowing physicians in the emergency department. At that time in my life, the exciting cases were generally the ones in which a life was lost: someone had to be shot to death or succumbing to a massive heart attack or chronic illness.

The following academic year, I studied abroad in Israel and had the opportunity to volunteer as an EMT for the Country's national ambulance service. I was awe-struck after my first failed resuscitation as my fellow rescuers paused before cleaning up to say a Jewish prayer for the deceased elderly woman laying lifeless on the cold tile floor of her narrow upstairs apartment. Because there were so many experienced rescuers on scene, I stood in the hallway and observed.

Back in Atlanta the next summer, I worked in a different emergency department where I'd finally get to participate as a medical provider in the "cool" cases. I remember the first time a patient report for a cardiac arrest was called in. I was so nervous because I had never performed CPR on a real person. When the paramedics arrived and the patient was transferred to the hospital bed, I was the first to do chest compressions. 

After doing continuous compressions for some time, my vision became blurry and my field of sight zoomed out as if I was adjusting the telescope of my brain. When the patient expired the staff exited the room one-by-one, tossing their sweaty gloves in the trash can, taking not even one second to think about what had just transpired, moving on with their other tasks. My focus returned, and I couldn't help but wonder why or how we do what we do.

Years later I became a paramedic and then a field training officer. I had become the medic who asked students if they had any questions, who continued my day after watching someone die, who could socialize and even laugh with my coworkers despite bearing witness to the tragedies that people - not patients, but people - face.

Even though I always felt strongly that a healthcare provider should explicitly show reverence to human life, it wasn't until recently that my behavior reflected this in death, as well.

Let me explain. 

I arrived at our local public academic hospital with a forty-year-old female who was found in cardiac arrest. While performing our duties on scene, my team and I were able get a brief return of spontaneous circulation. During transport to the emergency department, however, the patient became pulseless again. After a few rounds of CPR and advanced life support interventions in the emergency department, the resident physician pronounced the patient dead. He then asked for a moment of silence to show respect to the patient.

I asked the attending physician if this was a new practice, as I had never before seen such an expression at this hospital. He replied that one of the most compassionate physicians on staff instituted this practice a few years ago and has inspired all of the residents to do the same.

Later, I corresponded with that physician to let her know how far-reaching her impact was. I told her that I would begin to encourage other prehospital providers to take a moment of silence should resuscitation efforts be terminated on scene prior to transport.

She wrote back "It has and continues to be a humbling experience to remember life."

My first opportunity to perform this ritual in real-time was as a fill-in supervisor at the EMS agency for whom I work. I responded with an ambulance crew to a 911 call at a nursing facility to find a young man in his twenties in cardiac arrest. I treated him a weeks earlier when his tracheostomy stoma became clogged and required aggressive suctioning to maintain his airway. His unfortunate predicament was a result of injuries he sustained in a motor vehicle accident months prior and the numerous brain and orthopedic surgeries he underwent in the aftermath.

When our efforts became futile, I asked everyone to pause before cleaning up. I asked that we observe a moment of silence to remember this man's life, to respect his life, and mourn his death. I was met with a few looks of surprise as this practice was not only new to me, but apparently no one else, not the nurses, firefighters, police officer nor other paramedics had ever seen. When we left the patient's room, the entire team seemed touched.

Since then, myself and my team have observed a moment of silence at the conclusion of every resuscitation event terminated without transport. We've been told that we actually seem to care.  I've been told by family members of the deceased, bystanders and other healthcare providers that this expression, this extra moment spent on scene in peace and calm, is an honest communication that human life matters.  Even in the hustle and bustle, we stopped.  We took a moment.  We thought.  We mourned.  Together, we sung a symphony of silence in honor and memory of a person who lost their life, sending them off with dignity and respect after an otherwise dehumanizing presentation.

As I've written previously, whether on the job or not, I value human life. I work diligently to treat each and every patient with whom I interact as I would like to be treated myself; as if they were my own family, friend, or friend's family. I treat each patient knowing that they are someone's someone: mothers, fathers and children to someone; brothers and sisters to someone else.

That day, we took a moment to remember the life of someone’s someone. I saw just how important it is for us - all healthcare providers - to remember life, for life is what we are assigned to preserve and protect; to heal and comfort. It was and will continue to be a humbling experience to remember life. Even in death.