"We're doing everything we can," I said as I put my hand on the sobbing woman's shoulder. "We're going to keep trying for about 10 more minutes, but I don't know if we're going to be successful with this."
These are the moments that are truly difficult in my job. Telling people their loved ones have passed away, or preparing them for what seems inevitable.
"You can do it!" the woman said through tears, whispering in her husband's ear. The chest compressions continued. Thump…thump…thump…. "You're strong! I know you can make it!"
I felt the tears welling up in my eyes.
"Check the rhythm," I said as our EMT stopped the compressions. I watched the flat line track across the heart monitor. "Resume compressions."
At this point I knew that, in many ways, I was continuing these compressions for the patient's spouse, this woman who had stood by his side for so many years, and stood by his side now, urging him on. We had performed CPR for 20 minutes. For another 20 minutes prior to this, the EMTs had performed CPR. A flatline on the monitor at any point means a good outcome from CPR is extremely unlikely. Especially after 40 minutes.
But I also knew there was more to this process than the science and the medical knowledge. There is a certain therapy, a sense of being able to say goodbye, in being part of the efforts to provide CPR to a family member.
As our efforts continued for another few minutes, I stood next to the woman again.
"I'm so sorry," I said to her. "We've done everything we can. I don't know what else we can do at this point."
She held his head against her face and whispered in his ear. I nodded to the EMT performing chest compressions. He knew what I meant, and removed his hands from the patient's chest. Our resident ceased the slow, rhythmic process of delivering air to the lungs through the endotracheal tube.
"Time of death, 10:20," I said softly. The woman kissed her husband's forehead and said goodbye.
I've struggled, at times, with the idea of having family members present as we perform CPR. It can be a stressful time for everyone. For family members, it's disturbing to see your loved one with a tube in his throat, his chest being compressed 100 times a minute, and blood possibly coming from IVs and central lines.
But every family member who has been present during CPR thanked me for being part of that moment. They've thanked everyone involved. They've left the room knowing that we, as a medical team, did everything we could possibly do to save their loved one. And I think they—and I—have been better off because of it.
A study which just appeared in the New England Journal of Medicine confirmed the benefits of being present for CPR. Individuals who were in the room as their family member received CPR were much less likely to report anxiety or depression after their loved one's passing, and their presence did not interfere in any way with the medical staff's CPR efforts.
So, no, I don't look forward to those moments. It makes my heart ache to see interactions like those I witnessed in this case. It's tough to try to leave the room, to push aside the poignant emotion of what I have witnessed, and to catch up with the five or six new patients in the ER who have arrived while I've been performing CPR. But I later reflect on those moments as some of the most rewarding of what I do. We may not have saved a life, but we have eased the process of a family member's efforts to say goodbye at a time of death. And perhaps, as physicians, that is one of our greatest callings.
Reference: Jabre P, et al. . New England Journal of Medicine, March 14, 2013.