I saw someone die today. Code Blue. One minute my patient was alive, sick but not teetering on the edge of death sick, and suddenly her body lay in front of me, lifeless. The code ran for 45 minutes, which in hospital time is an eternity, especially when someone’s life is on the line. The teamwork exhibited by the doctors, nurses, respiratory therapists, pharmacists and everyone else in that room was nothing short of incredible, and all heroic measures were taken. Still, she didn’t make it.

Rewind to this morning. I rounded on Mrs. W, we’ll call her, which involved me asking her about any overnight events and how she was feeling, followed by a focused physical exam. I saved her for last that morning, because, to be totally honest, I didn’t look forward to seeing her. Some patients are pleasant, cooperative, grateful for your care, and some patients are…not. Mrs. W kept threatening to leave AMA (against medical advice), even though we kept trying to convince her that she needed to be in the hospital if she had any chance of recovery. This morning, I’m honestly not sure if Mrs. W was in a particularly bad mood or if she was starting to experience altered mental status due to her illness. It doesn’t matter. All I know is that when I tried to ask her how she was doing, she called me a bitch, saying that I enjoyed punishing her and I was responsible for her worsening. I felt like I had been slapped in the face. I have spent years of my life training so that I could help people, learning how to alleviate suffering and practicing good bedside manner. Today, that training was put to the test. I’M TRYING TO HELP YOU, I screamed in my head. Outwardly, I took a deep breath, told her to get some rest and that I would be back with the rest of the team later, and walked out of her room.

I try really hard not to let the words of others bother me. I told myself, “She’s sick, she’s miserable, she didn’t mean that.” It still hurt. It made me angry, it made me SO frustrated. None of that matters now. I’d be lying if I said I didn’t feel a little guilty for having those emotions, but I can’t change the feelings I experienced. I only hope that she didn’t see them written on my face despite my calm words.

Anyway, this afternoon, we were in the work room writing notes as usual when my senior resident jumped out of his seat, pager in hand. “Code Blue, it’s 822.” He took off running and I followed, not exactly sure what I was supposed to do in the moment. We got to the room and it was already full, the code in full swing. I stood outside the doorway and watched as my resident ran in, as respiratory tried to secure an airway, as a line of nurses performed chest compressions, as a slew of medications were being administered and different orders were being called out. I was in awe at how calm and collected the team was, even though it looked chaotic from the outside. I have never been so helpless. “Pulse check!” I heard, and I realized I was holding my breath. She had no pulse. Another cycle of CPR was begun. After about 25 minutes, I heard what I had been silently praying for. “I have a pulse!” “Somebody get the elevator up here,” the charge nurse called, “we’re going to the ICU.” I ran to the elevator bay and pushed the buttons frantically.

At this point, I had chills. She had narrowly avoided death. Thank God she didn’t leave AMA, I thought, and watched as a team of twenty wheeled her down to the ICU, breathing for her by squeezing a bag-valve mask the whole way. I found my senior on the phone, trying to contact the patient’s daughter. I could tell he was nervous, as her daughter did not have a good relationship with the medical team either.

“You were great in there,” I tell him. “I know she’s in bad shape, but at least you don’t have to tell her daughter that she didn’t survive.” I breathed a sigh of relief.

I spoke too soon.

“We’re losing her,” I heard as I turned toward the room she had arrived at. No. The scene unfolded the same way it had upstairs for 20 more minutes. The team was incredible, but it wasn’t enough. I heard them call the time of death and a lump rose in my throat. “Thank you for your hard work everyone,” the person running the code said to the room. Everyone filed out and returned to their stations, to the patients who still needed them, who were still alive. I stood in the doorway, watching the chaplain and the person whose job it was to clean up her body. “We can give you a minute,” the chaplain said. “No it’s okay,” I squeaked out. “I’m just..it’s just..she was my patient.” They stepped out while the 4^th year med student and I stood wordlessly over her. I’ll never forget that moment. I was angry at her just hours before, and now she was gone. I’m still processing, and I don’t know when or if I’ll come to terms with it. It’s not going to be the last death I see, I know. Medicine teaches you to develop a certain emotional fortitude, and well, I’m still learning.

Be kind, friends, always. Be patient. Everyone you meet is fighting a battle you don’t understand. Speak to people as if it were the last thing you ever say to them.