“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray”. 

Rene Leriche

I didn’t feel like a real doctor at all.

“I gotta go see if I can get my patient upstairs to stop going into V-tach.  She’s hellbent on dying.  By the way, don’t forget about the chest tube thing.  Clamp the end before you put it into the pleural space.  If you keep making messes like that, the nurses will hate you,” he finished, heading for the stairs. 

     Tad went back up to the intensive care unit to take care of his patients, and I stood there alone, looking at the body.  I had no idea how to tell this family the guy was dead.  That’s one thing a medical student never does.  I had no experience and no good idea how to approach them.  I glanced down at my feet.  There was blood all over my shoes and the bottoms of my scrubs.  I grabbed some shoe covers and put them on.  His family certainly didn’t need to see his blood splattered all over me. 

     I gathered the priest and the social worker for moral support, and headed to the waiting room.  I did not want to face this family alone.  I didn’t want to face them at all.  As I approached the waiting room, I got a glimpse of the people inside.  A woman a little older than me was sitting, holding a toddler, who was sleeping.  An older man and woman were with her. 

“That’s his wife, and his mother and an uncle,” the priest whispered to me. 

     I suddenly started to have this warm dizzy feeling.  My peripheral vision started to darken, and I thought I was going to pass out.  The cold sweat was back.  My throat felt thick and full, and my eyes started to burn.  I wasn’t sure I was going to be physically capable of speaking.  Oh my God, I’m going to pass out right here in the hall, I thought.  I was not in any way prepared to talk to this family.  Their day had probably started out just like every other day.  He had probably left earlier this evening to go out with some friends, said “Goodbye, I’ll see you later”.  Just like a million other times.  Just like my husband sometimes did.  He was the most important thing in her life, her husband, that little boy’s father.  Right at this moment, she still believed he was alive.  She would believe that until I walked into the room and spoke.  The words that came out of my mouth would devastate this whole family.  I wanted to turn around and walk away.

    I felt intense anger at the dead guy.  Why the hell did he do this to his family?  Why did he go get drunk and then kill himself and his friend with his truck?  How could he be so stupid?  If he hadn’t been such an irresponsible asshole, I wouldn’t be standing here having to tell his wife that he’s dead. 

    I paused for a minute, trying to suppress that nauseated feeling in the pit of my stomach, then walked into the room.  She slowly looked up at me, with such desperate hope in her eyes, searching my face.  She wanted me to tell her he was fine, that everything was alright, that she could see him now and talk to him.

     I cleared my throat and said in a quiet, shaky voice, ”I’m Dr. Sawmiller.  We did everything we could do, but his injuries were too severe.”  I couldn’t bring myself to say the words “died” or “passed away”.

“I am so sorry.  He didn’t survive,” I continued.

     I awkwardly reached out and put my hand on her shoulder, dropping down on one knee so that I was at eye level with her.

“He didn’t make it.  I’m so sorry.” 

     Nobody moved or spoke.  Her face was frozen in disbelief, then slowly overtaken by deep, lonely grief.  She hugged the child and just rocked back and forth, not saying anything for a few minutes.  She started to sob, and asked me, “How do I tell him his Daddy’s dead?  How do I tell him?  How do I tell him Daddy is dead?”

The other woman began repeating, “No, No, No, No” while she sank down and put her arms around the wife.

     I gave some details to the uncle, and left them with the priest.  I felt sick to my stomach and light-headed, the expression on that young wife’s face stuck in my head.  Zayed was standing in the hallway.  “Did you talk to the family?”

     I nodded my head.  I had already become aware that Zayed was not the sensitive, expressive type, and it was sort of awkward for him to be in the position of offering emotional support.  I must have looked pathetic enough that he felt forced to say something. 

“Don’t worry, it gets easier to talk to the families after you do it a few times.  There’s no way he could have made it.  People make stupid choices and they die, it’s not your fault or my fault.  You guys did a good job.” 

     I don’t think I ever used the words “died” or “passed away” when I told people their loved one had just died.  Somehow, the phrase “He didn’t survive” was easier for me to get out, as if this was something less than dying.  I have often wondered what people recall about that moment, the moment that I told them someone important in their life had just unexpectedly died.  I don’t recall much about most of them, except that they all looked at me with the same unrealistic hope in their eyes that the news I brought would be good.  And then I destroyed that hope, replaced it with miserable anguish and despair.  With a few brief words, their whole lives changed.  Is it all a blur?  Do they even remember my face or what I said?  Or do they vividly recall every detail, and hate me for what I told them?      

     Zayed was right, though.  The more often I had to tell a family bad news, the less it bothered me.  Over time, it just became part of the routine of taking care of trauma patients.  As Zayed strolled out the back door, my pager went off again.  The ER was looking for me.  They had a kid with right lower quadrant abdominal pain, maybe an appendicitis, and another guy with a big laceration that needed sutured.