"Is everything okay?", my boss asked me today. "Lately, everytime I look at you, you seem a million miles away". That's how my mid-year evaluation began today. How do I even begin to explain where I am? My best friend and lover for 3 1/2 years...the man I wanted to marry suddenly ended things for reasons that still perplex me. No matter where I go or what I do, this sadness never leaves me. Then I come to work, a chance to escape from my personal life and I get griped out along with the other residents on a weekly basis for behavior that I'm not even guilty of. I'm tired of it. Tired of everything.

This week was particularly difficult. It's been a month. Things should be getting better, but I still feel the same empty, lonely feeling. Monday morning didn't help things. I woke up with a horrible headache from grinding my teeth in my sleep...something I do when I'm under a lot of stress. The headache was still lingering when I got called to a code blue up on one of the floors. I got up there quicker than normal because I was right by a waiting elevator when my pager went off. I got up to the room and it was chaos. This 25 year old man was in bed, unresponsive. I could tell by looking at him he was already dead. Nurses were frantically trying to get an IV line in with no success. This guy had just been discharged from the hospital when he suddenly collapsed while getting dressed to go home. "Does he have a pulse?" I asked as I climbed to the head of the bed to get ready to intubate him. He didn't. CPR was started while I quickly intubated him. Something was wrong with the defibrillator and there still wasn't an IV in. One of the other residents jumped in and put an IV in the guy's neck so we could start giving epinephrine. Finally, the defibrillator started working. He was in v-fib. During the next hour, we gave him countless rounds of epinephrine, shocked his heart 10+ times, gave him a bolus of amiodarone then started a drip. A few minutes later the respiratory therapist had to suction his breathing tube because pulmonary edema fluid was coming up the tube. While she was suctioning, bloody fluid shot out of the tube like a geyser, hitting everyone who was standing around. We worked on him for an hour and never got him back. Finally I told everyone to stop. He was dead. Everybody was crying. He had some agonal respirations for about 5 more minutes while the nurses cleaned him up so the family could see him. It wasn't real breathing, just reflex breathing that sometimes happens when a healthy brain is dying. "Make sure he has stopped doing that before the family comes in or it will freak them out", I told everyone. He stopped about 2 mintues later, but the fluid kept coming up from his lungs for a long time. I wrote a death note in the chart and managed to make it to the elevator before I started crying. That was by far, the worst code I've had this year. The medical examiner accepted the case for autopsy, but then called back 20 minutes later saying they were going to rule the death as a pulmonary embolus.

The next day I was working on a discharge summary, depressed about my personal life, and still upset about the 25 year old man that couldn't be saved. Another resident, Adam came in and sat by me while he signed charts. "How much are you smoking now these days?" he asked me. "About half a pack a day", I replied. Adam looked at me and said, "you know you're better than that". Looking back, I think that is the nicest, most caring thing anybody has said to me all week.