There are moments in life that serve as a dividing line. These instants sharply incise our worlds into before and after, the then and the now. Moments shimmer like a crystalline barrier, allowing you to see so clearly through to what was, but that past is just out of reach. You can only run your fingers down the wall as you wave goodbye to the life that once was yours.
Often, these flashbulb moments are tragic, debris crumbling around your feet. Words confirm your worst fears, and you learn that the monsters in your nightmares actually live and walk your Earth. As an emergency physician, my voice is often the soundtrack to those instantaneous eons of devastation, playing over and over through someone’s mind as the world shatters around her.
There is a burden to being that voice. I have the terrible privilege of being the first person in the universe to know the psychological violence that I am about to inflict on someone, and I have to hold that in my heart for a time before I can release that pain to someone else. Whenever that realization dawns for me, my eyes squeeze shut, trying to block out the knowledge. I try to unsee the image that shows the bleeding, or the blood test that whispers of a tumor, or the monitor that tells me my efforts are not working. For just one heartbeat, I want to pretend that I do not have to go destroy someone. I say a silent prayer for the sorrow I am about to inflict, and I tiptoe to the patient’s bedside.
No matter how much I try to wrap my verbal daggers in soft tones and gentle delivery, there is no denying the violence that is their very essence. Once my blows land, there is a moment of recoil. Sometimes there is stunned silence. Often, there is a resigned sigh, followed by, “Doc, I was afraid of that.”
My voice is the sharp edge between when you were healthy and what is next: “We see a mass on your CT scan that looks like cancer.” These words carry the weight of biopsies, chemotherapy, radiation, surgeries, fear, questions about could my kids get this and how did it happen to me?
“I’m so sorry, but it looks like you have miscarried.” Those syllables erase the questions of boy or girl, should the baby’s room have jungle or farm animals? Every dream for a future dies at that moment, along with that tiny still heart. Those thoughts were only shadowy fears but are now etched in the stone of a memory by the chisel of my voice.
Running a code is a well scripted dance, with steps and twirls and medication pushes. If your partner does not follow your steps, the dance falls apart. I can usually tell within minutes if a code will be successful, but we keep trying for so much longer, because giving up is a brutal betrayal of the family’s desperate hopes.
The echo I hear in my dreams is the symphony of a child’s death. We worked on him for over an hour, despite knowing the moment he arrived that we would not be successful. You just do not give up on a little boy with skinned knees and laughing blue eyes. We paced through every algorithm, tried every fancy maneuver, used every medication. We tried to coerce a different answer by the sheer force of will of the dozens of people who worked on him. My team of loving hearts tried so hard to change the future we knew had been written before he ever came to our door.
Then, in the middle of the sound and fury of the resuscitation, my universe stilled as I accepted my duty. The team continued for another minute more because I could not bear to say the necessary words. No one else could say them, and that is the horrific price extracted from a doctor’s soul, knowing that we are the ones who have to voice those phonemes, string together the sounds that tear apart hearts. I could not find the air in my lungs to make the vocalization come out.
I did not call the words out, like in the movies. “Time of death…” was too savage. I went to the mama, pulled her hands into mine, and tears rained as I said, “I’m so sorry. We have tried everything, but he is gone. He is dead.” I said it quietly, but the words carried in the space created by my burden. That silence splintered with the sound of a soul ripping apart, as mom and dad collapsed. The wail of despair dissolved into, “He’s my baby! Please don’t give up on my son.” She clung to my legs, and I sunk to the floor amid the scattered detritus of medical wrappings to hold her in my arms. As I murmured, “I’msorryI’msorryI’msorry” over and over, my staff gently ceased their efforts.
Their hands softened, closing blue eyes, caressing tiny arms, holding tiny hands. They trailed fingers over him, over the invisible chasm in that family: the gaping hole between the last breath of a child and the parents’ first breath, punctuated by that anguish made manifest, in a world without that precious life.
I first described these moments as cutting and words like knives, because they feel sharp when I hold them inside me. I think instead a better analogy is an avulsion: these dividing lines in our lives are a rending of the soul, not clean or precise, but rather ragged and messy and surrounded by collateral damage. Incisions we can suture, cover up, heal with a tiny linear scar. So often my words to patients, my avulsions of life, really are more like torn out gaping holes, impossible to fill with any living tissue, riddled with painful nerve endings longing for their lost ends, raw to the world forever.