The Resuscitation Room and What it Means to Heal

The resuscitation room is often a sea of bodies which are usually alive, but sometimes dead or dying, and rarely empty. It is where the soul chooses either to stay and dance, or to evaporate.

It is a small room located in the far end of the emergency department, no bigger than a small garage. It is encased by walls, which are more like pillars in the corners, flanked by sliding glass doors. Inside, there are shelves and cabinets lining the back wall from floor to ceiling. Shelf space is occupied by boxes of medical instruments, neatly wrapped in their sterile packages like antique goods. The cabinets house a slew of devices: devices with screens; devices with knobs and levers; devices with on/off switches and devices with buttons and flashing lights.

On one side of the room, floors are lined with carts of different colors: red carts are for cardiac arrests; gray carts for personal protective equipment; blue carts for intravenous needles and bags of saline. On the opposite side of the room, garbage cans occupy floor space, along with intravenous poles and a small metal fridge with red blood cells inside, arranged in neat rows like chess pieces. In the center of the room, like a pedestal in an ancient temple, is a hospital stretcher draped with white blankets.

From a distance, bright blue light bleeds from inside the resuscitation room. The glow highlights the room among the many rooms beside it, like a deity among its disciples. Maybe its prominence is just a coincidence created by the lights inside, or maybe because it is the only room in the department stocked with everything you will ever need to save a person’s life, reserved only for the sickest of patients.

A click echos on the Department’s overhead speakers, followed by a fizz of static. Suddenly, my heart feels heavier, my ears pop, head slightly tilted with eyes looking up. “Notification to the resuscitation bay. ETA: 5 minutes.” Hordes of people rush to the resuscitation room.

My heart is now racing, my hands clenched and my tongue is quiet. My mind is formulating a list of all the ways a person can die: acute coronary syndromes, tension pneumothorax, septic shock, hemorrhage. My eyes pace back and forth as I watch the hospital staff prepare the room. The red cart is shuffled closer to the middle, the gray cart is cracked open and people put on hospital gowns and face masks. Devices are hailed from the cabinets, buttons are pressed, levers toggled, monitors turned on and a low toned beeping noise, with the rhythm of a slow heart beat, begins to pollute what was once a quiet room. The scene of so many people in the resuscitation room reminds me of the sea of people at a concert, throwing their hands up, dancing, moving, bumping into each other. Yet I stand perfectly still and I watch quietly at the head of the room. No one can understand the anxiety and excitement I feel at this moment — this must be how rockstars feel.

The list I compose in my head is done. Now, time to arrange it by things that will kill the patient the fastest. I calculate risk and mortality rates while I rearrange and revise my list. My brain is now processing numbers at a rate akin to a company’s fluctuating stock price at the New York Stock Exchange. Except at the end of the day, the currency that is exchanged is not money, it is the soul.

The charge nurse informs me that the patient is going to arrive by ambulance. Extricated from a car after an accident. ETA: 3 minutes.

I can eliminate a dozen things from my list.

The patient is middle aged, blood pressure is 70/30, heart rate 115 — this is bad. Again, I make a revision and I tack on a few more to my list of deadly things. ETA: 1 minute

Flashes of red & white siren lights ricochet off the walls just outside the resuscitation room. This is our signal that the ambulance has arrived. Peering down the hall into the ambulance bay, the beads of red & white siren lights becomes a blinding barrier to what lies behind it. A stretcher, flanked by two paramedics, pierces the veil of light, as they race towards us. The clicks and clanks of their stretched becomes louder as they get closer. Finally, a staccato of words rambles out of the paramedic’s mouth as she struggles to catch her breath in between words. She describes the events at the scene and transfers the patient onto our stretcher.

It looks bad. The patient’s head is wrapped in gauze, face is painted in blood, some of it already dried, some of it still oozing down and staining the canvas of the patient’s cheeks. The patient becomes agitated. I stand my ground at the head of the room and think.

Agitation can be a sign of trauma to the brain, especially after an accident. Blood in the brain can also be irritating leading to confusion and agitation.

We need to act fast.

The patient continues to thrash around in the stretcher: arms flailing, kicking, and screaming. The patient is deteriorating. Blood pressure drops, heart rate rises and now the patient becomes lethargic — not good.

“Crack the fridge. Let’s give blood and transfuse,” these are my first words.

It has been twenty minutes since the ambulance arrived and the patient continues to wax and wane into and out of consciousness. The blood pressure is steady, but not good. We have two large peripheral intravenous lines, we have given a slew medications, performed two life saving procedures and transfused blood. I have exhausted the list of deadly things in my head. Calculations of risk and mortality has come to a halt and I am now out of ideas.

I have spent a decade of my life learning the science of the human body. I know the path that blood takes to get to every organ, I can meticulously calculate the next best diagnostic test and I can compose a treatment plan specific to every patient’s needs. We have to be missing something. I go over the list of deadly things in my head once more.

We will continue to transfuse blood, but what next? Another medication? More diagnostic testing? I need to think of something quick. I ask the nurse for the patient’s identification number so I can pull up his medical record.

Nothing.

This is the most I have moved from my position since the patient arrived. The patient’s blood pressure drops dangerously low and his heart rate continues to rises. Impending shock and death.

This patient must have a family. I need to inform them of the patient’s poor condition. But where are they? I do not even know this patient’s name.

What is His name?

I walk over to this Man, and it is the first time I smell His musk, a mixture of blood and sweat. He lies flat, still and exhausted on the stretcher completely naked, uncovered, exposed and cold. The white sheets beneath Him are now stained red and pink. He has a tube hanging from His left chest which enters His thoracic cavity, which we placed earlier to save His life. Blood drips like syrup from this incision onto a puddle on the floor. His arms next to His sides, with hands clenched, just like mine. He has multiple tattoos on His forearms, one of which is in the shape of a noble military insignia, he’s a veteran. I nod unconsciously thanking Him for His service. As I move closer, His pupils, which are partly covered by the blood soaked gauze wrapped around His head, come into focus. He has deep seeded, dark blue eyes which are now motionless, piercing the ceiling above Him. I gently place my hand on His forearm, and I feel His coarse tremors. Is He scared? Maybe He is cold? Maybe both? I cover the Man in warm blankets, hiding His tattoos, keeping Him warm and shielding His dignity.

I kneel closer and look into His eyes. He looks back. I realize this is the first time we have made eye contact since He arrived into the resuscitation bay. As I lean closer, the definition of sweat and blood on His face becomes sharper, like diamonds and rubies on a jewelers leather mat. Sweat and blood pool around His deep seeded eyes. I wipe away the sweat from His cheeks, dab the blood from the wrinkles around His eyes. He sighs in relief. I learn forward next to His ear as I kneel closer towards the floor and I whisper.

Suddenly, I am relieved of my calculations and the list of deadly things becomes a distant memory.

On His monitor, His heart rate returns to normal, He is calm and His blood pressure rises. We make eye contact once more. I sense His wordless gratitude and I see His soul settled in His eyes, dancing.