Life in Triage

I saw my first death a few days ago.

Going through medical school, of course, you see your share of dead bodies. Heck, I spent an entire semester in a large room filled with about 100 of them. Dead bodies are old news. This was the first time, however, I witnessed someone transition from being alive to being dead. It was strange, but in the complete opposite way that I expected. The oddity was in its complete nonchalance, even from me.

She came in with a ruptured thoracic aortic aneurysm, already a grim diagnosis. Most people don’t even make it to the hospital, and even then the majority of those that do don’t survive. Already under general anesthesia when I first saw her, she was never a real person to me, I suppose. They laid her on the table, turned her halfway on her side, and flayed her open. Dr. Safi works incredibly fast, and in under 5 minutes we had been through skin, fat, and fascia, cut out 2 ribs, incised the pleura, retracted the lung and found it…the 2-3cm hole in a tube that was about to kill this woman.

We operated for about 45 minutes. About 15 minutes in, the EEG went flat. Due to the massive infusion of IV fluids she was getting, she developed some problems with her potassium and her heart began to fibrillate. I’ll never forget how it looked. First, the heart was beating like any other heart, then it looked as if it were a bag filled up with small worms. It writhed and writhed, producing some crazy patterns on the EKG. Paddles were brought over to shock the heart back into a rhythm, only to have it begin to fibrillate again 2 or 3 beats later.

Both surgeons were sewing with alacrity, but it was (apparently) all in vain. Suddenly, without any warning, Dr. Safi threw his needle driver and pickups down, and shouted: “Case over! Call time of death.” Anesthesia was dissatisfied with this. “Give me 5 more minutes,” he asked Safi, who had already scrubbed out and was beginning to write. “Fine, fine” he replied. Dr. Estrera kept operating for a few minutes, then the anesthesiologist was satisfied. “Ok, case over. Time of death 10:15.”

And that was it. No trumpets, no grim reaper, no…nothing. Anesthesia was still keeping her body functioning for the moment, so there was no real change in her physiology. But she was, for medical purposes, alive one minute and dead the next. Over the course of the next few minutes, as anesthesia began to remove their supports and we began to close, I watched the heart begin to writhe slower and slower. We had closed up the cavity before it completely stopped. We closed the wound roughly, it was just going to be opened again by the coroner. Even after that, it wasn’t much different than dealing with a live anesthetized patient. We cleaned the blood off her chest, undid the drapes, and put blankets on her.

The only difference was, this time there was one covering her face.