EMWRaP – Emergency Medicine Writing, Rhetoric and Practice

April 25th, 2022 – Click to view (PDF) of “Secondhand Bruises”

Tonight, meteorites slide across the sky like little shards of glass, melting into the darkness. There is pressure behind your eyes, your pupils dilating, straining to see any flash of movement. Standing alone in the desert on a moonless night, just you and the meteorites. Your ears feel as though they are filled with cotton, your eyes deceive you and your fingers tell you there must be movement, but its only your own pulse tickling your nerve endings. Black and white, the world has lost its dimensionality, your ephemeral self slips into 2D. The cool, air stings as it steals the humidity from inside your chest. And still your pupils are gaping open, aching against themselves, straining to see any flash of movement in the velvet blackness.

Still and quiet. You will remember this night for the rest of your life. There was nothing more we could have done.

Ultrasound. From Latin, “ultra-,“ meaning “beyond,” and “son,“ for noise, a musical note.

Is silence beyond sound?

With an ultrasound probe in my hand, I can see deep into your heart. I can stop your pain at the source. I can watch your viscera churn complacently like a herd of cattle chewing cud. I can meet your unborn child or watch the breath enter and exit your lungs. With the ultrasound probe in my hand, I can show the world that you are dead. Time of death: 17:30.

A living heart on an ultrasound looks like a nervous catcher’s mitt. It flaps open and closed, living life to the beat of its own rhythm. The valves clap jubilantly, the walls rumble robustly and the whole thing trembles merrily with knobby, flappy girth. As you age, it might thicken like sun-damaged skin if your water pressure is too high. A blocked pipe might cause it to quiver like an anxious rabbit, unable to shake off the fluttering panic and get back to real life—or it might result in a permanent gimp so that one wall of those meaty ventricles lags behind the rest, the weakest link. Alcohol, smoking, age, chemicals or heart attacks can cause your plump pumper to stretch and thin like an old man’s tighty whiteys, so that it can never snap back to its youthful elasticity. Momentum. That’s what they all share. Vibrant kinesis. Potential energy. Electricity. Without that vibrant kinesis, your heart is no longer a heart, it’s just a limp sac of stagnant blood. On ultrasound, it is a footprint filled with quiet water that reflects only the stillness of the night sky back at you. If the cardiac arrest was recent, the surface of the puddle swirls gently as though it was stirred by a breath of wind so that the motes of pollen drift slowly around its surface. This was a traumatic cardiac arrest, and it was not recent. The ultrasound screen is as still as the silence of the 2D desert night. Time of death: 17:30.

  Call it what it is.

Until we call it, death is very bouncy. A trauma bay is not too far removed from a clown car in a Vegas show. There are more people than should realistically ever be occupying a room together, especially during a global COVID-19 pandemic. We have comedic flatulence as we blow air into a dead person’s lungs. Slapstick humor as we strip them naked and then whale away on their chest trying to keep the blood circulating to the brain. We’ve even got the trick flowers that shoot water into unsuspecting eyes, but instead of a flower it’s a femoral line.

And it is blood instead of water. Wear eye protection.

We would make poor clowns though. From the head of the bed, I watch my friends and co-workers work together efficiently each pulling their weight like huskies in the Iditarod. A single person who cannot get an IV holds up the whole team and delays the dash to the CT scanner. We would have to work on our act if we were ever going to make it in Vegas—there is no comedy here. In the synchronized pause, it’s my job to slip the ultrasound probe between the sea of arms toward the young patient’s belly so that I can peek upward at his silent heart. Call it. 17:30.

Anna and I called eight numbers before we found the one that worked. The first emergency contact number answered: “Hola?” This is Dr. Malachi calling from the Maple Valley Medical Center ER. Is this Myrtle?

A stream of Spanish and then silence. My eyebrows collide like fuzzy magnets as I glance at Anna. I think… they just hung up? Try again. This time I say, “Is this Myrtle? I’m calling about Todd.” He dissolves into uncontrollable giggles and hangs up again. I don’t think that was Myrtle. We try the next number. And the next. And the next. I’m listening to the voicemail for the county sheriff’s office and I just heard the voicemail message for Goldstar Grocery HR department after attempts six and seven.

Almost a habit now, I glance down at my sheet of scribbles between each call as though that will help me figure out what to say when I do find Myrtle.

Todd John Doe

Myrtle Hill, 1112223333, 1112224435, 5552223131 ← Stag Doe 4453321111, 0001112222

Are you ___?

I’m calling to tell you

Todd was in a motorcycle…

Heart Ø beating → CPR

Brought to us…

Did everything we could do…

But unfortunately, he died.

It’s all written in hot pink pen so my tired eyes don’t have to see that 2D black and white.

“This is Dr. Malachi calling from the Maple Valley Medical Center ER. Is this Myrtle?”

“Yes. What’s wrong?”

“I’m calling about your son, Todd.”

“Oh, God. Is he ok?”

“Umm. He was in an accident.

“Oh no. Oh God. Is he dead?”

“Yes, Ma’am. I’m so sorry ….”

Her scream pierced my skull and sliced through my brain before it made its way out through my right ear to be free in the darkness of the Universe.

For a few seconds, I felt as though I’d been pulled through the phone line by the raw anguish of her scream. I sat beside her in her dining room as her…partner? Son? Friend? Tried to understand what happened and then began to comfort her. I sat there awkwardly in a dining room chair in case she had any questions. I was supposed to tell her that if she wanted to come to see him she can, but I was starting to realize that there would be no window for my words to slide through to her consciousness… as the line went dead.

Usually, when the dead patients come into the ER it doesn’t bother me. Their souls have already left this world and the cooling flesh that was left behind is no more human than the table it sits on.

The grief is universal though.

Watching a dead man’s wife sob quietly, apologetically outside his room in her delicate teal cashmere sweater and seeing the glistening tears leak out between her tarnished wedding ring and the soft, swollen purple veins of her fingers bruises my heart. I can only hope that one day, when I am that woman, I have trained hard enough for my turn—that the daily accumulation of secondhand bruises harden into a single impenetrable callus that will see me through my own judgement day in an ER somewhere.

Or I hope that I go first, because I am still afraid that I will not be able to bear this when it is my turn to hear,

“We did the best that we could do. Despite all our efforts, I’m so sorry, but your husband died.”

I hope that my heart will be protected from the pain I see on the face of my dead patients’ grief-stricken families. We are nothing without the people we love. The people that love us.

Dead. Died. Deceased.

We are taught that it is important to say those definitive words.

He is dead.

She died.

In the moment of shock, the human brain, supposedly, cannot comprehend anything but the most concrete of ideas. Dead. Is that concrete enough for you?

Sometimes, despite our best efforts, it is not concrete enough for us. Sometimes, we try harder and longer than we should. Sometimes, especially when we swirl helplessly around the corpse of a child, we flail impotently against the inevitable. In this case, my own brain betrayed me. I saw his tattoo and his softly worn macramé bracelet that circled his lifelike right wrist. He looked alive, a curly haired high-school senior, perhaps. It got to me. I imagined rustling into physics in a rush, late to first period and finding out that my classmate had died last night.

Then in the family waiting room, I saw a seemingly endless number of permutations of him as he could have been in the grieving, disbelieving, shocked faces of his half a dozen younger siblings. They all had his hair. His eyes. I had asked to do this. I wanted to make myself face the family. As I walked them back to the room where his body cooled, we passed the other family. Their beautiful daughter, twenty something, had been thrown from her car as it rolled. Unrestrained driver. Her thick hair didn’t hide the hideous gash to the back of her head. The C-collar couldn’t stop her broken neck from moving in unnatural, unsustainable ways. Wear your seatbelt. Don’t text while driving.

I felt like the grim reaper with my black sleeves under my blue scrubs. Two young traumatic cardiac arrests in one night, back-to-back. What are the chances?

I hope that my heart has learned from this.

Someday, I hope that my secondhand bruises carry me through the pain that I see in their eyes.