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29 year old white female brought to the ER by ambulance at 2:30am 7/2/06 after her husband heard her gasp for breath and then pass out while sleeping. He immediately calls 911.

when they rolled her through the doors from the ambulance bay doors, i had a sinking feeling. she was already intubated and the paramedics were still doing chest compressions. the monitors showing asystole - no electrical activity in her heart.

the rest of her clothes are removed and the fury of activity ensued. she was petite, and upon removing her pants, it was impossible not to notice the swelling of her abdomen. a catheter was immediately placed into her bladder and a urine pregnancy test was run. meds are being pushed; more IVs are started; her hands and feet are blue and her face is dusky; the respiratory therapist is manning her airway and breathing for her; a paramedic continues to beat for her heart.

the urine pregnancy test is negative. how can that be?

word arrives that her family is here and i'm sent out to get some history. what meds is she taking? does she have any medical problems?

a nurse beat me to it and comes back with the info. she's 3 months post-pardum. she takes some meds for depression, but they don't know the name of it. she also has a 6 year old daughter and her 3 month old daughter has a serious heart condition for which she has already undergone one open heart surgery.

the cycles of cpr continue as the doctor and i go out to speak with the family. he explains that the only explainations for her condition is a blood clot in her lungs or that she had overdosed on some medications trying to hurt herself. but she hadn't been trying to hurt herself. she had been sleeping. we were waiting for some medicine from the pharmacy that would help break up the clot.

her husband and parents came back to the room with us.

the doctor takes over chest compressions as the family adjusts to the picture before them. she regains a pulse, but it's slow and weak. more drugs are pushed. she's in v-tach and needs to be shocked. everyone backs up. her mom clutches me and i hold onto her. the jolt makes her body jump, and noone in the room breathes, as if our holding our breath would will hers to somehow return.

a medic takes over chest compressions for a few minutes. cpr continues. the doctor points at me and tells me to take over chest compressions. i do. but it's hard. i get tired after only a couple of minutes and am relieved by the medic. the activity continues.

her husband begins rubbing her feet, and i imagine that she's probably begged for him to rub her feet. i wonder if he did. her mom holds her hand and begs for God to help her baby. she knows it's out of our hands.

the clot busting medicine has been in for about 18 minutes. if nothing has changed by 20 minutes, the doctor says we have exhausted our options. but she miraculously regains a pulse just in time. more meds are pushed and she is rushed to CT for a scan. she maintains her pulse throughout the scan, but when she gets back, it begins to weaken again, and then it fades completely.

it's about 4:30am now. cpr is continuing. i've long since lost hope that there could be a good outcome. my heart is breaking for her husband; her mom and dad; her babies.

i'm sent to see other patients who have been waiting almost three hours at this point. it's hard to feel sympathy for them. their "emergencies" are so minor that i want to scream at them. at some point, while i am with a little old lady who fell out of bed, the doctor calls it. i can hear the crying of the mom in the hallway. my heart hurts. i'm sewing a laceration on a drunk guys hand from where he hit a mirror and i hear the little baby crying in the waiting room. a sob catches in my throat. i am selfishly glad that i didn't see the older daughter.

there are likely no good answers. and there are definitely no words to ease their pain. i just hope they recognize that we did the best we could. and i hope they know that our hearts are breaking for them.

and i silently wonder what i've gotten myself into.