stared at my shoes in the ICU

Today, I did chest compressions on a patient who died.

This man looked like a million bucks yesterday. He was my favorite patient on my service yesterday. He had a pneumonia but he was jovial, he was animated, he was teasing his wife. Overnight, he got transferred to the ICU and just plummeted off the cliff from okay to bleeding from everywhere from an overwhelming infection.

I felt like someone had punched me in the gut. It was the first time I could not really talk to family about a patient's death. I understood, biologically, pathophysiologically, how what happened had happened. I know that things were done appropriately, the right decisions were made, that despite our best efforts, sometimes we can't win. I got all that, logically.

But everything inside of me was twisted up from the suddenness of it all. Internists don't do sudden. We usually have time to prepare and accept and make peace. We usually have relationships with families and patients. We are not trauma surgeons. We don't roll someone into our unit and watch them die before our eyes a day later. Only we did today, and I found myself unequal to the task of reckoning with that. And I will never forget it.