An excerpt from The Healer’s Burden: Stories and Poems of Professional Grief.

Leaning on the door of Trauma Bay 1, I survey the remains of my latest failure. The story is told in the bloody and jumbled instrument trays, monitors now silent and dark. In the center of the room sits a gurney covered with a white sheet and an unmistakable human form. Blood radiates outward on the sheet-like ruined rose petals. On the floor, maroon swatches catch patterned footprints here and there, like those of a hiker tracking through mud rather than this path through a man’s essence.

I would have been a terrible gambler. I’ve been told a thousand times that I save far more than I lose, but it is an empty platitude. I have always agonized over losses far more than the satisfaction of any wins. Las Vegas would not want me.

John Doe 57 rolled in as so many before. “Hispanic male, mid-twenties, multiple stab wounds to the chest, no palpable blood pressure,” the EMT said. Typical 3 a.m. patient. My team pounced. I was the trauma attending, responsible for this enthusiastic and optimistic crew. Lines going, blood running, chest compressions, and ventilation proceeding—all was fine. Blood poured from the left chest, and I knew what must come next.

I called for the chest tray, a command that assured every nearby provider would soon cram the room to watch that most invasive of procedures: thoracotomy. I can always feel their gaze like a heat lamp on my back when this call is made.

I splashed betadine and made the long left chest incision, spreading the ribs and gazing into a cavity no person should ever see. Upon opening the pericardium, the weakly pulsing heart was more grey than red, with a visible wound. One quick suture, and the hole was sealed. John Doe 57’s heart-filled, and I thought I saw it pink up a bit, or was that just hope? The heart still beat rapidly, but as I helped its compression, I could tell that the muscle had lost its vitality. We soldiered on, shocking, replenishing blood, breathing for him, but it was all in vain. Eventually, I knew that as the lead, I must make the fateful call—03:44, time of death. Faster than the room had filled, team members slid away; nothing more to see here.

Now the room is silent as if nothing at all occurred. I stand watching the red stain forming on the pristine white sheet, mocking me in my failure. I trained at excellent institutions, survived residency, and served in combat. Now, here at a Level 1 trauma center, I could not save this life with every possible medical tool at my disposal. This injury, this particular injury, always has, and forever will, haunt my dreams. The hubris to think that I could be the difference, that I am better than those who came before me, was answered tonight, as it has been before, by this deserved slap in the face.

I absorb the charged silence; my mind wanders back to my third year of medical school. I was doing well, a moderate prodigy of the medical department. I was ready for every conference, every patient, well-read and well prepared, until that fateful day.

Richard Morand is a trauma surgeon and contributor to The Healer’s Burden: Stories and Poems of Professional Grief.

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