Nurses are known for gallows humor. Perhaps it is our way of dealing with a profession where we experience situations that we can’t help but carry home at the end of our workday. It doesn’t justify the comments that I have heard, or sometimes thought, and yes, even said. But making those less-than-professional comments acts as a pressure valve when faced with unspeakable tragedies, or bearing witness to acts that make you wonder if some individuals simply have no souls.

One frequent saying among those I worked with in the emergency room at a small hospital was, “Karma got him.” This phrase served as a catch-all for nearly every fatality when we could not utter the thoughts that really permeated our minds. When an individual arrived dead following a motor vehicle accident and a heavy odor of alcohol could be detected on their clothing. If someone who was brought in and could not be successfully resuscitated with obvious evidence of drug or alcohol abuse. Or in the case of one juvenile who expired, a frequent visitor to our facility when the police would bring him in with a can of octane boost clutched tight in his hand from huffing. Only this time his mouth and hands covered in paint from inhaling thick fumes that had ultimately stopped his heart. The summation was the same once the physician made his pronouncement: Karma.

As individuals follow a continuum of life, do we tally up points of positives and negatives in a banking system of Karma? Many religions believe so. Each one gives it a slightly different slant, but the spiritual reasoning follows the same trend that what you put forth, you will eventually get back. It makes sense that if you consume alcohol to excess, your liver will harden until cirrhosis sets in. Eat to excess and the fat will eventually accumulate until it impairs your cardiac function. Partake of tobacco and the carcinogens accumulate in your body. None of these things are truly spiritual, so they can’t really be blamed on Karma.

What is the causality that brings forth the wrath of Karma that we encounter in the emergency room bays? Intoxication driving seems to be the cause for the driver, but it doesn’t justify those the driver kills in the same accident. Drugs taken in an overdose? Perhaps. But not the angst inflicted upon the family when someone must go inform them of the patient’s demise and watch their suffering. Other tragedies that you can’t begin to attribute to any rational purpose, to any explanation, such as the loss of a young life. Some things you just can’t fathom and you’ll go insane trying to make sense of the situation.

We don’t know the histories on the patients that arrive barely clinging to life, or some who have already expired. The paramedics are only continuing compressions long enough for a physician to pronounce. Whether the individual lived a good life, had a positive balance in their Karma account, was an exemplary being, we have no idea. If they committed misdeeds against others, in this life or another, it’s not part of their medical record. As nurses we do our best to try and resuscitate them with the methods and drugs available, working in conjunction with a physician until we are told to stop, that our actions are futile. All we can do is try looking past the situation until it is called.

Perhaps Karma is better defined as a defense statement by some nurses for those that couldn’t be saved. We tried our best. Did everything perfectly. And still the patient expired. Karma.

The hospital didn’t offer counseling. We didn’t have a chaplain or anyone other than each other to talk to after an incident. Most of the time we stayed busy completing the necessary paperwork as the police would stand in the hallway and talk to family. You could hear their radios and it always enunciated that there had been another tragedy. The coroner would send a technician to come retrieve the body, and as the shift wore on there was always silence between the staff as things slowed down. Grieving family would leave. Housekeeping cleaned and removed all trash, the crash cart was replenished by the house supervisor, and everything returned to a florescent, industrial state.

We opted not to talk. It didn’t do much good. If Karma was the blanket response for a situation, ultimately someone would say it, rather than divulge thoughts that tumbled inside our heads. It may not have been appropriate, but it helped with the inexplicable.