pomegranates

this was my second call shift.  or maybe it was my fourth.  i was excited for once, because of the people i was going to get to work with: an R-3 with a gentle heart and nerves of steel, and an R-2 who was more of the same.

i'd responded to rapid response calls in the hospital in the same way since medical school: with passing interest, focus returning to my own work within a few seconds.  today, because of the way things were scheduled, or perhaps because of the stars aligning, or perhaps due to dumb luck, i was doing nothing when a code blue rang throughout the hospital in the early afternoon.

i sprinted up the stairwell -- something i usually reserved for important things, like a page telling me to come to the floor to write for an order for a patient to be off telemetry for a procedure even though they'd been gone from the floor for hours.  you know, the real important stuff.  i had no precognition, no spidey sense tingling, telling me this was going to be any different.  yet i ran.

i arrived at the patient's room to find four or five frantic nurses, three attendings, and two other residents, one of whom sat astride the patient.  i quickly slipped on a pair of gloves.  something was happening.  a small, rubbery looking man was laid flat, his mouth agape, a scarlet color brilliantly splashed across his hospital gown, the sheets, the mattress, his hands.  his skin was sallow, and as his chest was being compressed at over 120 beats per minute by an RN, his arms and chin flopped back and forth in the graceful manner only possessed by ragdolls.  he was so small.  so small, i remember thinking.  so bendable.  so malleable.  does he really exist?  is this a real person?  dark crimson continued to spill over his lips and onto the hospital bed.

i almost expected a lilting classical melody to begin playing, like in those scenes in movies where bodies explode on a battleground in slow motion and black and white.  but then i heard it, the voice of one of the attendings above the cinematically muted din of EKG beeps, nurses, bag-mask air, the springs in that goddamn shitty hospital mattress as an RN pushed down on the patient's chest repeatedly.  "Who else can take over compressions?"

the first sensation i felt during that first compression i performed, to my great horror, was a gentle crunch.  before my mind had time to process it, i was feeling it again.  crunch. crunch.  faster compressions!  crunch crunch crunch.   his sternum had completely given way and separated from his rib cage.  his arms continued to dance up and down upon the bedsheets.  crunch crunch crunch.  in my periphery, i made note of the anesthesiologist attempting to intubate, for i would have to stop at his command.  my central focus, however, was on this yellow rubber mannequin they had put in this hospital bed.  i could see nothing but his taut yellow skin over his bloated plastic body.  the faded blue of his hospital gown.  and trickles of deep purple oozing out of the corners of his mouth, coating his teeth, streaking his neck, pooling at his ears.  i could feel nothing but his brutalized cartilage.  crunch crunch crunch.

"I think i see seeds." "I don't think this is blood."  "pomegranate, it looks like he was eating pomegranate seeds."  or maybe blackberries, or raspberries, i thought to myself.  they don't carry pomegranates in this hospital.  maybe he got them from a well-meaning family member?  a friend?  my arms started to burn.  beads of sweat rolled down my cheeks.  How long had it been?  Hours?  "Push the epi."  "Let's do a pulse check."  "Where's the glucometer?"  "I can't get his airway."   "I need more suction, now."  I hear the attending's voice, "Are you getting tired?"  "Yes," someone replied.  Was that me?   "Who can take over compressions?"

It felt like years before another set of hands came to relieve me.  But then once I got off the body, the minutes turned into nanoseconds, and suddenly someone had found a pulse and he was whisked off to the ICU.

I learned later that I actually did know this patient.  He was on my service briefly several weeks prior with renal failure, and had recently been admitted again.  I learned later from the nurse taking care of him that he had been eating some fruit, and when she came in to give him his medications several minutes after she saw him, he was unresponsive, red juices spilling from his mouth.  He likely choked on that fruit and aspirated, blocking his airway irreversibly.  And in the greater scheme of things, given how sick he was, the patient was headed towards a trip in a body bag sooner rather than later.  I later saw his family weeping uncontrollably outside the ICU doors.

Despite learning these things -- despite having touched him, listened to his body with a stethoscope, despite having spoken to him in my awkward halting spanish just weeks before -- I feel so disturbed that in my memory, he will always be a mannequin.  A tepid ragdoll.  A broken rubber figure.  Covered, like a murder victim, in such sweet, crunchy, seedy fruit.