What do you do when you know someone is going to die? I’m not talking about death when it comes at the end of a long protracted illness or a terminal diagnosis. Or the final act at the end of a “good” life, when the body and mind have ultimately given way. I’m talking about when you realize the twenty-five-year-old woman in front of you, who you met five minutes ago, has no idea she will not survive to see another sunrise.
Moonlighting during residency in the ICU of a community hospital, I was summoned to the ED to evaluate a feverish, septic young woman. In his book, Blink, Malcolm Gladwell describes the gut/reflexive first impression we make before our “thinking” brain starts getting in the way of those initial thoughts. Walking into the ER bay, all the warning bells were ringing. The mottling of her skin told me she was in shock. The visible, rapid rise and fall of her chest told me she was working hard to compensate for an acidosis. Her eyes told me she was afraid, and rightfully so. The rapid pulse and low blood pressure were punctuated by red on the monitor up in the corner of the room. She looked sick, but the reality was much worse. I had known her now all of ten seconds. But I didn’t know she was dead. Not just yet.