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Wake Up, You Are Dying

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On my last day of medical school, I saw my first ever acute death of a patient. I had seen dying patients before then, even wrote a couple death summaries, but it was always the old, frail, declining patient where you saw it coming. Surrounded by family, the movie type death.

This time around though I was on an emergency medicine shift, 7pm-3am. It was my last day as a medical student. It was bitter sweet. I was about to graduate and get that M.D. after my name, but it also meant more responsibility and feeling like, damn I better know my shit.

In the emerg, when there is an acute case about to come in, EMS will give a heads up to the department and the charge nurse will do the same as she lets the attending physician know that something is coming in. This can be a stroke, heart attack, suicide attempt, car accident, you name it.

This particular night, it was the latter, a car accident.

The nurse ran over and told my attending 
“2 vehicle collision, airbags deployed, windshield broken, driver VSA on scene. ETA 30 minutes”

VSA on scene? What the hell is that? I don’t remember reading that in any med school lecture.

The doctor I was working with looked over at me and asked “Do you know what the chances of survival are after being VSA on scene?” 

He saw my puzzled face and realized I didn’t know what that meant. He made a gesture with his hand signalling “zero”. Then he proceeded to tell me, that VSA meant vital signs absent. 

The driver was pretty much dead on scene and was being brought to hospital as more or less a formality, so the doctor could announce the death, write the death certificate and the logistics could be taken care of.

This shook me up a bit, but the shift went on and I got back to work as we awaited EMS to bring him in.

A few minutes later, the trauma code team assembled outside the resuscitation room, and the patient was brought in. He was hooked up to LUCAS, an automatic CPR machine used by EMS (google it). It aggressively pressed on his chest over and over again in keeping with how a code is run.

They hooked him up to all the wires and manually breathed for him through a bag. The trauma team lead doctor did an ultrasound of the chest, and couldn’t even see the heart on the screen, there was too much subcutaneous emphysema and “internal organ shifting” as my staff doctor explained it. They ran through the protocol as a formality and announced his death. Everyone went back to their part of the department and got back to work.

I stood at the end of the room, trying to stay out of the way but also curious. His ankle was dislocated, as was his shoulder. He had a huge laceration on his forehead, probably from the windshield. His eyes were still somewhat open, but no signs of life. 

Then I found out the part that really shook me awake. He was a 22 year old kid. Zoomed through a stop sign, and that was it, gone. I remember his name and face to this day.

A few minutes later the nurse came to the trauma team leader and said “The family is on the way”. He asked calmly, like it was nothing, like he had done it a thousand times before “Do they know he’s dead?”. She answered, yes, and went back to her chair. 

He got back to work. As did the rest of the department. On to the next patient. On to the next task. I don’t blame them, you have to move on to helping the patients that can still use your help. You would lose your mind if you got caught up in every patient that died in this field.

I was just a medical student, not quite a seasoned vet. I couldn’t move along so quick. I went to the bathroom to collect my thoughts.

This 22 year old kid just died, his body is laying there 20 feet from me, lifeless. His shocked family is on the way to see it. His mother that birthed him, his father that hoped to see his young boy do things in this world. All gone. Any dreams he had, vision he wanted to pursue, ceased to exist that night. All with a “Do they know he’s dead” to cap it off. And on the world went, without him. 

It hit me so hard because I was 26 years old at this time with soulless eyes myself. I was still alive in the sense that I had a pulse, but beyond that I had been existing more than living. I wasn’t all too happy with where my life was even though it looked like success from the outside looking in. 

I got into med school my first try, I had built up a nice little physique for myself. I was making my parents proud. All that was fine, but I felt completely dead inside. I felt like I was living a life that someone else had decided for me. My life’s work, genuine curiosities and true desires were locked away a long time ago.

I looked to my future, which I was just reminded was not guaranteed, and I did not like what I saw. I didn’t want to just keep on this conveyer belt and do what everyone else was doing. It may make them happy, but it is not for me. I wanted to create, to build and to use the opportunities, blessing and abilities my creator gave me to do what truly lights me up.

I was always a storyteller, comedian, builder and entrepreneur as a kid. All that got pushed to the side in favour of the safe path of becoming a physician. You know how it is in immigrant families; doctor, lawyer, engineer or failure. 

I didn’t hate being a physician, but I always saw it as the thing I was made to do, rather than what I chose to do. It didn’t help that the whole process of medical training is standardized into jumping through hoops, regardless of your unique traits and interests. I saw it as in the way of my life’s work rather than part of it.

I saw the other physicians I worked with, operating the conveyer belt of patients that came through with the same conditions, the same medications, the same broken promises to themselves.

They made good money, they were well respected, had safe jobs and all the things your parents want for you.

Many were happy, or at least put on a good show. Many were visibly stressed with little control over their lives but in too deep to do anything about it.

That fateful day in the ER, I was on the path to becoming a surgeon. Another 5 years of residency training, probably a year or two of fellowship then fighting and clawing for a job afterwards. And then living within the new confines of whatever group I would join at that time as I would be the most junior surgeon, and as the saying goes in medicine, “shit rolls downhill”. 

I loved the surgeons I worked with as a student. Never felt like work. We joked around, had fun and they were damn good at their jobs.

Did I want to be a surgeon? No. I wanted the title, the status and the money they made. I had no interest in the process. I didn’t appreciate at the time, that the process is all there is. When I studied those topics, it was forced and just enough to impress who I was working with.

After that mini existential crisis on the last day of medical school, I did a complete 180 and switched the specialty I was pursuing to primary care. I did not want to operate the conveyer belt of signing prescriptions or replacing joints. 

I wanted to practice medicine my way, focused on prevention and digging deeper into the root cause of patient’s problems instead of doing patch work on symptoms. In many cases these root causes are hidden in their own decisions. 

I wanted to make medicine part of my life and do it in a way that allowed for my inherent interests and curiosities to be brought to life. Doing primary care opened a world of freedom and flexibility to me, to allow me to build and explore my creative endeavours away from work.

The process never ends, but I am much happier now. I am building my life’s work, of which this platform is a part, while approaching my job in a whole new light. I actually enjoy being a physician more than I ever have because I get to practice it on my terms and help people with those root causes. I get to involve my inherent interests of psychology, purpose, existence and try to understand why people make the decisions they do, while educating my patients in these realms.

I have revived my childhood love of writing and creation and building around my genuine curiosities and passions. I hope this work serves others, but at the very least, it allows thoughts in my head to be expressed in the world as I make sense of them.

I made a promise to myself to live intentionally from that day forward and question every decision I was making and who I made it for.

I encourage you to do the same. Don’t follow the path laid out by someone else. Learn from everyone and taste what is out there, to design your own path.

This is not a dress rehearsal, it’s your one and only existence that is fragile and must be lived with conviction and purpose. 

One day, the curtains will close and the stage of life will no longer be yours. The rest of the world will move on and as will you, to a realm we are unsure of. All that will remain is the work you expressed from your soul and how it touched the rest of us.

Wake up, you are dying. Live with intention and allow that faint voice in your heart to be heard by the masses. 

Go on your second pursuit. 

Cheers

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