Opinion

A PIECE OF MY We Are Drowning

MIND

Diana Halloran, MD We are drowning. But really, I’m angry at myself. How can I feel this
Department of “14-year-old male, gunshot wound to the chest and way? How can I be thinking these things? I hold empa-
Emergency Medicine, back, pronounced dead on arrival.” thy for patients and human connection in the highest
Northwestern
“28-year-old female, front seat restrained passen- regard. I want to understand people, to reach them
Memorial Hospital,
Chicago, Illinois. ger in motor vehicle accident, distal upper extremity frac- where they are. So how did this happen? I feel dis-
ture. The driver pronounced dead at the scene.” gusted with myself. I feel empty. I tell my parents
I’m sitting in morning report listening to the bar- about the patient I saw die in front of me in the emer-
rage of death and tragedy again. Just 5 minutes ago, gency department. I remember the patient’s eyes—
I overheard a colleague tell a patient their partner afraid. A massive gastrointestinal bleed, we did every-
had died. I listened to the patient’s sobs through the thing we could, but the patient didn’t survive. The
thin curtain, her devastation without privacy. Then patient’s family stood nearby watching as I inserted
watched as the same colleague pivoted from breaking the endotracheal tube. I remember the patient’s
her heart to presenting the overnight trauma patients glasses; I took them off and tossed them aside in the
minutes later. fray as I prepared to intubate; tiny drops of blood cov-
I’m a second-year emergency medicine resident, ered the lenses. Where did I put them? Did the family
and I am exhausted. Every day, I bear witness to trag- get the glasses back?
edies. I watch as patients experience the worst days of I feel disconnected from my nonmedical friends
their lives. Pronouncing patients dead and hearing the and family. It’s difficult to relate to them and difficult to
cries of their loved ones. And immediately after these care about other issues like world events and politics.
events, often horrible tragedies, on top of worsening My friends in business school joke about their bad days
emotional fatigue—my colleagues and I are expected at work, their colleagues, their emails. Meanwhile, my
to just get on with it. We finish our notes, call consul- bad day at work is a child dying in front of me. Hearing
tants, check off our to-do boxes, and see the next his mother’s screams as she falls to the ground, hands
patient. Sometimes this is easy. We’ve learned to clutching the hospital bed as we declare time of death.
Blood on the sheets. The alarming of
the ventilator.
I am constantly on high alert. I jump
As health care workers, we are
at noises—the sounds of people run-
overworked, exhausted, suffering, ning, raised voices. The noise of a wheel-
and emotionally drained—and the system chair being pushed past me into the
trauma bay, the patient slumped and
simply does not provide time to cope. unresponsive. My pager going off and
saying, “CARDIAC ARREST.” These signs
suppress our emotions, compartmentalize, and deal always accompany tragedy. They always indicate a criti-
with death and loss by not dealing with it. We become cally ill patient, an unexpected code, intubation, death.
callous, jaded, cynical. I’ve seen this during codes— My colleagues and I witness so much tragedy.
“No way we get them back.” “Drunk driving, probably.” I tried to protect myself by not feeling but that has
“Maybe at least I’ll get a chest tube out of this.” Flip- made me hardened and angry. I didn’t know how else
pant comments, just another code, just another to protect myself because feeling the pain all of the
death. We have done this before. This won’t be a time was too much. But I don’t want to feel angry, dis-
problem. And maybe it won’t be, until it is. Until this missive, and patronizing. I see others doing the same,
not dealing with the emotional turmoil surfaces in and I see myself in them. “Another COVID-positive
other ways. patient who’s not vaccinated. I can’t even care at this
I feel this internal disquiet, unease, even after just point,” or “The patient just needs to toughen up.”
Corresponding
Author: Diana
a few years. I’m angry—angry at patients. Why did this As health care workers, we are overworked,
Halloran, MD, patient come in during my night shift for earwax exhausted, suffering, and emotionally drained—and
Department of impaction? Do they really have nowhere else to go, no the system simply does not provide time to cope.
Emergency Medicine,
urgent care to call? Oh, and the next patient isn’t vac- I stand in the doorway of that child’s room, the
Northwestern
Memorial Hospital, 211 cinated against COVID-19, even after all of this time. mother still laying across the bed. I am frozen. I can’t
E Ontario St, Ste 200, Don’t they know about the dozens of deaths I’ve pro- think except to wonder where the nearest bathroom
Chicago, IL 60611 nounced upstairs in the intensive care unit? Selfish. is as my eyes start to water. My phone rings. There’s
(diana.halloran@
Inexcusable. In the next room, my patient wants to another patient. I have to go. I tear myself away from
northwestern.edu).
leave against medical advice. I can’t help but think, the tragedy in front of me.
Section Editor: Preeti
Malani, MD, MSJ, “One less hand-off to give, one less hospitalist to give For many physicians, therapy is still largely seen as
Associate Editor. report to.” I feel numb. a weakness and psychiatric medications are still talked

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 Opinion A Piece of My Mind
about in whispers. Sure, it’s true we have come a long way as a pro-
fession. Sure, we have group debriefs. Sure, we talk about difficult
cases more than before. But we have so far to go. I have colleagues
who budget for and pay out of pocket for therapy and antidepres-
sants, afraid that their vulnerability will be detrimental to their
future careers. Others don’t seek help at all. In reality, they are right
to be skeptical. Change is needed. We need less stigma around
mental health and more access to no-cost therapy through resi-
dency and beyond. We need the ability to take a few hours, maybe
even a day, after a traumatic case as opposed to feeling guilty about
calling in sick while a another resident has to cover. We deserve
Conflict of Interest Disclosures: None reported.
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© 2022 American Medical Association. All rights reserved.
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more time and space to process and heal. We can’t help our
patients heal if we are breaking inside too.
I’m trying to be more present in my sadness. After a code ends
and time of death is called, I stay for a bit and observe a moment of
silence. I take this time to feel the pain before getting back to work
as usual—honoring the patient, mourning them. On my drive home,
I can still hear the heartbreaking screams of that mother echoing in
my ears. I still remember the way my patient with the gastrointesti-
nal bleeding looked at me, face pale and afraid. I see these patients
over and over again and feel flashes of heartbreak. I won’t forget
them. I can’t.
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