SGIM Forum

Breadth: Part I

Massive Transfusion

Dr. Min (minea@upmc.edu) is a second-year Internal Medicine resident in the Department of Medicine at the University of Pittsburgh Medical Center.

Her last words to you, her mom, before the breathing tube went in, were, “Don’t let me die.”

I can hear the panic in your voice as you race down Forbes, past Carlow, towards the garage, “Don’t let my baby die!”

You were at the bedside every day (except four days, you’ll admit begrudgingly), for the last month and a half.

We acknowledge the force of your immense love, even as it takes the form of a daily interrogation and careful examination of every lab result. Back in the team room, we mull over the latest round of questioning, but behind our musings is the bright bulb of respect. Some people’s families never come at all.

As I dial the number to your cell phone, it’s becoming apparent that there’s no blood, not enough blood in the world, that can pump the life back into your child. We call for a massive transfusion and watch the telemetry scrunch like an accordion, watch as the QRS complexes undulate.

I hear your ragged breathing and imagine you weaving in and out of traffic. We stay on the line, together, as you arrive at the garage and rush into the building. You’re pleading for the elevator to hurry up—how many times have I joked with other residents about the slow elevators without a second thought? Now each second that drags on is sheer agony.

On the phone, the only thing I can think to say is, “I’m here.”

The hysteria that comes out of the telephone when I tell you we’re doing CPR is too much to bear.

Or that’s what I think, until I see you barreling down the hallway, face red and tortured and tearful, weeping and howling—now this is too much to bear.

When we give bad news, we are taught to state gravely, “I’m worried that…”

I’m worried that the lack of response to CPR and massive quantities of blood means that your child is never coming back. I’m worried that, after spending probably every waking moment of the last six weeks caring for and loving your child, you’re going to fall apart. I’m worried that no massive transfusion—of love, of support, of answers, will heal you from what you experienced today.

I think maybe I should be worried that I can’t forget your child’s face or yours, but instead I’m grateful. Etched in the recesses of my mind are the details of our mutual grief—from very different perspectives we have reached this final conclusion. Weeks later, I’ll hear that you were exceptionally kind and understanding after the initial trauma. I hear that you acknowledge to the grief-stricken medical team, in the face of your own unimaginable loss, that there are fates worse than death. I hear all of this much later—but in the first moment that I saw you barreling down that hallway screaming, I did what I should have done weeks ago and held you in an embrace.


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