“I see,” said the blind man.
-English expression
Once again, I’m cramped in a narrow armchair in front of the department head’s enormous desk, trying to suppress shivers. Why is it so much colder in here than in the rest of the hospital? It is 4 p.m. on post-call Monday. I’m still wearing an N95 and wrinkled scrubs from the end of the internship weekend on-call shift. My skin feels filmy and itchy, as if I’m molting.
There he is, in his pressed shirt, tie and crisp white coat, silently reading his notes. His walls are decorated with hanging laurels—diplomas, honor societies, “Best Doctors in America.”
He cuts to the chase. I didn’t respond to the code blue last night. While explaining that I froze, he interrupts me, admonishing that one day soon I’ll have to run these codes. He moves out from behind the desk, tells me to get some rest, and gives me a patronizing pat on the shoulder before rushing out of his office and down the hallway. Get some rest. Like that’s going to help.
The sensor is broken, and it takes all of my weight to push open the heavy door to exit in the rear of the building. I am not quite ready to head home, and the garden courtyard steps across from the hospital beckon. Fallen leaves swirl at my feet. The air is cool with a slight breeze that carries the musky-sweet aroma of plants preparing for winter. Burnt orange sun glow completes the setting. Autumn’s liminal beauty lifts my mood.
It is during my walks home through the park at dusk when the memory usually surfaces. I’m on break from school for the holidays. A similar brisk fall morning, and I’m rounding the final bend of my daily jog. Something is wrong. People are gathered around in front of our house. Someone is on the ground. Why aren’t they doing anything? “He’s unconscious,” they say, “He’s not breathing!”
My father is lying there motionless and looking up at me. His expressive eyes, which in life could tell a whole story with a glance, are now swollen and vacant. People are crowded around watching me perform hysterical CPR. Their mouths are moving, but I hear nothing.
Midway through third year of medical school, I run to my first hospital cardiac arrest. In the patient’s room, the resident, arms outstretched and hands clenched, pumps up and down on an elderly man’s chest like a jackhammer. There is a nauseating crunch of ribs breaking. The patient’s face is my father’s face, mouth open, eyes like black holes, his existence slowly transmigrating into nothingness.
A month or so later, at the next one, it happens again. My father’s face. And soon into internship again. And then I stop showing up for the codes.
My final meeting with the department head is on a pre-call day, so I’m clean and well groomed, but still no match for his high style. He leans forward, rests his crossed arms on the continent of a desk, and looks at me with tight lips for a few long seconds.
“So you’re almost a second-year resident, and you haven’t run a code yet.”
“No, s-” I choke a little and try again after clearing my throat. “No, sir. I haven’t.”
“You know, I just don’t get it. When I was a resident, running codes was a thrill, a rite of passage, unless you were in psych or pathology. True, most of the time patients didn’t survive, but we all loved the drama. Everyone always looked up to the resident who had the most composure during codes.”
He loses me at “running codes was a thrill.” Trying to revive my dad was no thrill. It was terrifying, surreal, heartbreaking, and physically and mentally depleting. Worse yet, it is emotionally interminable. A recurring nightmare, impervious to work expectations or any desire for recognition.
I have no memory of how the meeting ends. I recall another repulsive shoulder pat, and then I head down the hospital corridor in a trance until my pager goes off and startles me to attention.
On the way home that evening, I stop at the pharmacy and purchase an extra-large padded envelope, large enough to fit my embroidered white coat and name badge. I get home and decide to make a nice meal and drink a glass of wine. Will any new insights surface which impact my resolve while I am under the anxiolytic spell of satiety and cabernet? No, and I am content.
I fold the white coat neatly, place it in the envelope, and tuck in the name badge. I sit at my desk and boot up the Internet. It doesn’t take long to find the local news article about my “heroic” but unsuccessful attempt to revive my dad after his cardiac arrest years ago. I print out a copy and place it face up, on top of my coat and badge. The thought crosses my mind to add a short explanation or official resignation letter, but I decide against it. I think the message is abundantly clear as is. I seal the envelope and affix the department head’s address along with proper postage.
After I drop the envelope off at the post office the next morning, I sit in my idling car and imagine the department head unsealing it and examining the contents. Perhaps it will pry his eyes open, but too late for me. I am gone.
Dr. Jeffrey Millstein is a physician at Penn Medicine.
