The Smell of Death

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Lucia Derks

 Lucia Derks

Year in Medical School: Class of 2013

Place of birth:
Columbia, South Carolina

Where you grew up:
Columbia, South Carolina

College: Wake Forest University

Major in College:
Psychology

Minor in College:
Spanish

Goals (medical school and beyond): Never lose my childhood compassion for all people

Personal Philosophy on life and/or medicine: Life and medicine are what you make of it.

Favorite quote: “Do what you feel in your heart to be right - for you'll be criticized for it anyway.” - Eleanor Roosevelt

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Lucia Derks

What a strange feeling: to smell death, to feel it in the air.  The recognition of it slaps me across the face and leaves me blinking, wide eyed, disoriented.  Oddly there is no sadness, no remorse.  After all, he wasn't my father, my grandfather, or my brother.  I pause to reflect on the appropriateness of my emotions and dare to identify what they even are.  'I just started 3rd year rotations,' I think to myself.  'Where is the powerpoint slide for this?'

It was 9:30AM, day two of Internal Medicine, day two of third year of medical school, and we were on rounds in the CCU.  A pager goes off, hurried mumbling, the word "code", the air lights up with electricity, and my head starts to swirl.  Then I feel a tap on my shoulder, and it's one of the residents telling me to run after them.  'Who is them?' I briefly wonder until the resident points down the hall, and I see the fellow and an intern disappearing around a corner. 

I start to run.  'Stupid, you have a bad knee,' I curse to myself as the pain of the previous week's injury gnaws at my leg.  No time for excuses, I think to myself and try to pick up the pace.  I feel silly in my leather dress shoes and heavily overstuffed white coat.  No time for vanity either, I add to myself.

I catch up to the pair at the elevator, and anticlimactically, we wait for the notoriously slow elevators to arrive and board with a janitor and hospital volunteer.  I thought we would be flying down the stairs, catching them two at a time, a race against the clock.  But finally we arrive at the basement and trot the rest of the way to the Emergency Department.  I was told on the elevator that a man is coding in the ED and that we are here to evaluate whether he can be taken to the cardiac catheter lab once he is resuscitated.

Through the doors and first thing we see is a large man in a contact precaution gown with one hand rapidly pressing on a supine man's chest.  'Cardiac massage?' I wonder.  Having just completed ACLS training, the timing seemed entirely too fast.  I chided myself for being too critical, but as the rapid CPR continued, I leaned over to the intern and asked if it looked wrong.  He confirmed that it did.  What an awkward position to be in, as the newly arrived CCU team and me, just a med student.  I thought it better not to say something, and now I hope that next time will be different.

"He's been coding for an hour and ten minutes," a nurse tells us.

"There's a pulse!" someone exclaims, and then the rhythm returns to ventricular fibrillation.  I silently calculate the number of times that he has probably been shocked at this point.  My stomach knots a little, and I find something else to think about.

An attending tells a nurse to bring in the mother who arrives teary-eyed to stare at her 51 year old son in his plaid boxers having people compress his chest.  In disbelief she relates how he has been having chest pain for the past two weeks, but had not found the time to visit the doctor.  He was a single dad who had dropped off his seven year old daughter at school that morning.  She starts to cry.  I can feel the heat rising in my face, and my hands start to shake.  I have to look away from her.  I can't let her make this personal for me, can't get sucked in.  I make myself busy by getting his medical record number.  After all, I had just observed ACLS in action, one of the procedures to be observed for graduation.  I feel bad for pursuing a trivial matter in someone's time of need.  What a helpless feeling.

Shortly after she arrives, they obtain her consent to discontinue CPR.  He can't be helped; he can't be saved.  His mother loses her ability to stand, overwhelmed by what lies ahead of her.  She wasn't supposed to out-live her son.

The CCU fellow signals the intern and I that it is time to go.  There would be no cardiac intervention that day.  Rounds would continue as usual.  After all, he wasn't my father, my grandfather, or my brother.  He was the first patient I saw die, the first to slap me in the face with his death, and I will never forget that feeling, that smell. 

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Last Updated: 09-07-2012
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