When my father died, I was not in the same town. He was taken from his assisted living center by ambulance and experienced a cardiac arrest, dying in the local emergency department. I did not speak with those who cared for him, being many hours away. But I know how these things look, sound and feel. There is a consistency to the choreography of resuscitation. There is the sound of stretchers, of CPR, of oxygen hissing, orders given and alarms beeping. (Unlike television medical dramas, there is little yelling. It is almost always counter-productive and mostly done by the young and unseasoned.) And when the physician in charge decides that it is time to stop, when it is obvious that this patient will not survive, there is an incredible and abrupt silence for a few seconds. Then work goes on, cleaning the room, and moving to the next patient.
I do know that those who were there did their best. He was sick and he was weary. I feel comfort knowing that he was in the caring hands of members of my own tribe of physicians and nurses, medics and techs. The tribe of those who staff emergency departments day and night doing what they can with great passion, saving many lives and sometimes losing the fight.
Since I wasn’t there, I’d just like to say to them, ‘thank you so much!’ I should have written a note or stopped by to say hello. I should have sent candy or pizza or cookies or something. I know that small gestures matter. But when these things happen, life takes over. There are arrangements to make, family members to comfort, formalities to address. Those acts of gratitude which we intend to send sometimes slip through the cracks of our busy lives and are forgotten.
I could say the same for each of my grandparents, aunts and uncles, cousins and friends who died over the years. To those who saw them in their clinics or in the resuscitation bays where they died, or simply tended to them in the nursing homes where they resided, thank you! Your jobs are so important and yet so often underappreciated. It is hard work, this profession of maintaining human beings who are, each and every one, destined to leave this earth.
I do know from experience that sometimes, families in times of duress are unkind. They are frightened, shocked or angry when their loved one is critically ill or dies. Sometimes they threaten investigations or lawsuits. Other times they promise revenge. (Once, when I told a man that his brother had been stabbed to death, he punched the door so hard that a police officer came running, thinking the sound was a gunshot.) But you, in your diligence, did the right thing, provided for the needs of even the most taxing families, and did so in the midst of all of their anxiety and all of their sometimes sharp words.
You were there when they learned of the death, screamed and collapsed on the floor. The hair on the back of your neck and arms stood up and that tsunami of grief threatened to knock you over as well. But you kept yourself calm, you tempered your voice, you brought bottles of water or cups of coffee. You spoke gently. You called friends, family or clergy as needed. You called funeral homes at the end. Frequently those people didn’t think to thank you for what you did. So I will say it. Thank you.
In all too many instances, the people you cared for were victims of terrible and unimagined tragedy. They were high school students in car crashes or young parents with unknown heart problems, victims of unforeseen infections or complications of procedures. Sometimes they died from overdoses.
Others of you were providing care in times of war and watched the life drain from soldiers, sailors, airmen and marines despite your best efforts. Still others responded to the uncontrolled chaos disasters which are indiscriminate in their murderous machinations.
All of these people you cared for were fine until suddenly they were not. It is often the case that in these situations, the very nature of the event means that nobody remembers to come to you, to shake your hand, to hold you, to tell you that what you did mattered. To say ‘it’s not your fault, I understand.’
So you were left to your own shaking sobs, your own knowledge that you tried your best and the comfort of those who loved you. You were left to end your shift, contemplate, call or see your own family, then recover and return the very next day, coffee in hand, your own wound fresh as well. But let me say, now, for those who couldn’t thank you because of the emotional weight of the event, or the logistics or geography of the situation, thank you for being there. You did all you could in the situation you were dealt.
Sometimes, those you cared for had, quite literally, nobody. I have had patients die of overdoses, and when we called their next of kin we were told, ‘good, it’s about time.’ The line clicked off.
Many of those you have cared for, especially at the end, had not so much as a next of kin listed to hang up on you. Some were homeless due to disastrous lives, mental illness or drugs and had no ID. It was left to the police and the coroner’s office to see if anyone was available anywhere who might know them, much less grieve them.
Others simply had nobody because they were old, widowed, childless or friendless. The last person who touched them and cared for their earthly form was…you. And when they died, you gave their bodies dignity and covered them, turned out the lights and waited to see if their was anyone, which there wasn’t. So for that, let me say thank you. You treated them as humans deserve at the end.
It is easy to say, in such situations, that your job was thankless. Sometimes it feels that way, especially as medicine is ever and again transformed from a beautiful art through an incredible science and into simply a factory floor churning money for larger interests.
But it is not thankless. You know the value of your calling. And you know that thanks or not, you honor the humanity of your charges. You know that those who loved them are glad you were there, to offer what you could, whether or not they say it.
Your work, if nothing else, honors the fact that every man and woman was once someone’s child. As a person who believes this life is not all, I think that perhaps across eternity, those parents are thanking you too.
And I am confident that your kindness does not go unseen by the God of the Universe.
So for what it’s worth, and for those who never did and never will come to you and offer a kind word for what you did, I will repeat one last time, for my own people and those who had no people,
Thank you.
What you do matters and always will.
Edwin
PS If you don’t mind, please consider posting this in your clinic, hospital floor, ER, ICU, EMS room, etc. I’d like this message to get out there to the many people who deserve thanks that they don’t receive.
It is one of the most difficult parts of our job (profession). The concept that you are "well until you are not" is overwhelming for us all. I shared your essay with my residents. Thanks for doing what you do.
I’m retired after forty years in the ER and your essay brought back the feelings and made me cry. Thanks, Ed
Have a wonderful Easter!