The Transience of Life

In the 19 years that I was active as a volunteer EMS member of my local fire department (2 years NREMT-Basic + 17 years NREMT-Paramedic), I was often amazed at the difference between a "scene" on the day of getting a call, versus the same location a day or two later.

I'd pull up on a horrific motor vehicle crash...car into tree...partial rollover...pinned screaming pt. You work to stabilize/extricate/transport the victim of the crash. Do the paperwork, and move on. Same with a shooting....stabilize, transport, "wash down" the ground to clean away the blood.....and move on.

A day or two later, I'd be on my way home from work, and might drive by the same location. Sun shining, pretty green grass. Maybe a scrape on the bark of the tree, a little shattered glass or a discarded rubber glove on the ground, but nothing else to indicate that this is the location where a human life ended or was forever changed. Just another spot of ground...nothing more.

Now, as an ICU nurse, I sometimes experience the same dichotomy ("here" vs "not-here"). A couple days ago, I was taking care of an elderly pt with a dissecting/ruptured AAA. While in the OR, the pt received 16 units of packed red blood cells, 18 units of platelets, 8 units of FFP, 6 liters of fluid, and 4 liters of fluid from the intraoperative "cell saver".

Upon arrival to our ICU, the surgeon was very straightforward with the pt's family....the pt was not likely to survive.

Over the next couple days, the pt ended up getting multiple units of PRBC and platelets, along with liters and liters of fluid (plus pressors and hemostatic agents). The pt's family (spouse and children) hoped for the best, while the medical staff could see (from blood work) that multiple organ systems were failing.

The pt's family ended up withdrawing care....finally...after multiple "talks."

The pt's body was still in the room yesterday (awaiting transport to our hospital morgue) when I came into work. The body was eventually removed, leaving an empty room.

And the room remains....a bare, sterile room in our ICU. Ready for the next patient. The only sign of the deceased is the family contact information written on the dry-erase board.

As with scraped tree bark, the family contact information is the only (short lived) sign of yet another human having passed from this world to the next. Wipe it off with a paper towel....set up the room for the next patient.

Transient...Here vs not here.