This question was originally posted on Quora.com and was answered by Christopher Yerington, Founder - Physicians Income Protection at Physicians Income Protection (2017-present) The patient, in the pre-operative area, had been a hospital nurse. She said she remembered me from when I was an Intern at her hospital. She was so happy I was her anesthesiologist! I vaguely remembered her from years ago. She joked with me about how ‘green’ I had been… some of the younger nurses used to call me to the floors to “look” at patients in the middle of the night shifts (to get a Tylenol order) and she then laughed, “Honey, they just wanted to talk with your young hot stuff!” You guys judge: 20 years ago: Young, I was, hot, I don’t really know. The surgeon came into pre-op and said that we would be doing mostly local anesthesia for the procedure because her kidneys and liver were in “rough shape.” I had just finished saying that to her. We smiled at one another as the surgeon walked off after signing. Now I remembered her more clearly, killer smile, she had. I gave her very little sedation, maybe 20% of a light dose of sedation. She was a “pro” at receiving surgery; this was her 38th procedure in just three years. Bad kidney disease. This one was a little painful. The surgeon attempting to relieve blocked circulation and restore flow in her arm. I gave her additional medications but in baby doses. Total time, 45 minutes, and then we finished and she was still and quiet. All finished, we removed the surgical blue drapes. The OR team was spot-on and we had her moved over in less than a minute to the recovery bed. I would have normally hooked up all the same anesthesia monitors to her for transport (I was anal about that, anal about proper procedures and a stickler) but we were in the OR right outside PACU. It was 25 feet from where she was physically. Not a general anesthetic. I did put the pulse-ox on (always) and she was 86–87% - not great so… I hooked up additional oxygen of about 3L per nasal cannula — that took a moment because the O2 tank on the cart was low, so I got a new one from the wall on the back of the OR. I thought about the EKG and blood pressure cuff but she had not been a general anesthetic and I just sort of “felt” it was okay to hang out for a few moments with her so we (the room nurse and I) waited for her to be a little more aroused to move. A minute passed. We just calmly waited. The steady beep of the pulse ox was rhythmic. One more minute. I recall being utterly calm in this moment. Oddly calm. Years later I still remember this calmness and have spoken about it to my wife (also an anesthesiologist) on and off. Brandi, the room nurse said, “Chris… I…” It was sudden awakening, I had already sensed something as Brandi started to speak… something was not right and my hand shot to her jaw. I lifted her chin. Opened her airway and felt for breath on my hand. I hurriedly put my stethoscope in my ears and put it on her chest. I heard nothing. Listened harder. Damn. I grabbed it and flipped the bevel 180 degrees and then tapped on it — the sound exploding in my ears! Stethoscope back to her chest… “Chris, she’s not breathing.” “Brandi, there’s no heartbeat. Get help, get the crash cart. Call a code.” When you “call” a code blue in the operating rooms, literally EVERYTHING is right there either in the room or just outside to run the code and people arrive within seconds. We began the ACLS protocol and I had her intubated in 2 seconds (everything right there), anesthesia machine breathing for her within 5 seconds and CPR initiated. The surgeon burst back in the room and said some choice words followed by, “Stop. Stop everything. She’s a DNR.” Oh no. How did I not know that!?! He said, “She changed it this morning. I knew, but it was a local case… a conference with her primary physician.” He trailed off like he was reading something in the chart, ”We operated, I mean… I mean we did this to help ease her pain in that arm.” Long pause. “What happened?” His tone grew loud again, bordered on angry. “I’m not sure. Her pulse ox was showing 86% and a heartbeat but when I listened, she was asystolic? I don’t know what happened. I don’t know.” My voice was raised now. We stopped. I pulled the breathing tube out. The surgeon called time of death. He left to go see the family. We did what we always do to clean and straighten the body. New sheets. Everything neat. Never really thought about it but watching it happen was comforting. I felt disoriented a bit. Did I fuck up? How? I filled out a bunch of paperwork and then I headed to the recovery area called the PACU (post anesthesia care unit). My next case had been moved to another operating room with another anesthesiologist. I peeked in on that case, he gave me a thumbs up. I closed the door. I checked in on my previous case to release them to go upstairs from the PACU. That sign-out done, I pored through the chart of my dead patient wondering how I had missed the damn DNR (Do Not Resuscitate). The surgeon came to me, from behind where I was sitting, hand on my shoulder and said, “The family would like to see you.” No sense of anything in his voice. My mind was frustrated because I do not make mistakes, my heart was heavy because it hurts to lose a patient, any patient, under any circumstances… and now, I have to go face the family which is not something anesthesiologists routinely do even with operating room deaths. In general, the surgeon handles the family and the communications. I had done work in palliative care for a time. I was good at patient-family interactions even in tragic cases. Nine of them in the family waiting area… too many to go into one of the small conference rooms. The woman’s daughter, spitting image of her, just 30 years younger approached me and… kept coming and arms outreached… she hugged me. Softly she spoke, “Thank you for being there with her. Thank you so much,” her voice ending in a whisper. She squeezed tightly and my chest tightened on the inside reflexively with confusion and just plain raw emotion. More family members approached the hug. I was enveloped by… just love, is what it was… Love. They finally stopped. There I stood, one white doctor with nine black family members around him. It was almost like I could see us all, like I was looking down on the ten of us from above. So it wasn’t the patient who said something that made me die a little on the inside… it was her daughter: “My mama talked about you 10 years ago. She’d get those young nurses to call you up for little things because you always came up to the floor and cared.” I was so confused on the inside as to what was happening. I briefly considered I was in a dream, maybe. My eyes got teary. I recognized her daughter just then, she’s a nurse in the surgical ICU. She kept talking, calm almost, “I checked in to see who would be in the room with her and when I told her she got so happy it was you. Mama had been seeing angels all day yesterday. She changed her DNR because she knew she would die today. Said it was going be with you. Said she was ready. Said she was happy.” She then cried. I cried. I cried harder. They hugged me. I felt deeply confused. They said “thank you” to me. When it was over, I walked away stunned down deep to my own core of beliefs and my human limits of understanding this journey called Life. I felt myself being walked away and I entered the elevator. It was empty. When the doors closed, I cried by myself and in that moment a little piece of me that I had built up for years to be strong and impervious and to withstand the rigors of medicine… it simply died. That part of me never came back, never built back up. After that case I felt more. More of everything in Life. Over time it made me a better physician and then perhaps a better man. One year to that day… one year exactly, was my last operative day as an anesthesiologist. My left arm failed, left hand stopped working properly and I was forced several months later on to what turned out to be permanent disability. Although I cried and pained over losing my career many times, I do not think I have ever been as deeply emotionally hit by anything as hard as that daughter’s words that day… I felt so small in a world I maybe did not fully understand despite my education and dedication to understanding it. So tiny. Whether you believe or not in something more than humans in the universe… sometimes the universe shows you things that cannot, will not, nor do they need to be explained for that part of you that is more than mind and body… something deep within us appreciates and learns from these moments… and even, yes, sometimes, a piece of us dies a little from living life so fully. ~Chris Dr. Christopher Yerington Columbus, Ohio Bio: Retired from clinical anesthesiology by a disability in 2010, Dr. Yerington has turned his love of teaching and service to others to his family, medical colleagues and community. He speaks, writes and educates medical groups and residency programs about the importance of great disability and life insurance, basic physician-financial literacy and work-life balance. Chris also consoles and counsels young doctors on stress, burnout and physician-suicide. Having attended law and business schools, Chris is a perpetual student of human life, a scientist and an optimistic futurist in his heart. Source
