Viewpoint

STEPPING BACK

By Jimmy L. Moss, M.D., FSUCOM Class of 2010, Anesthesiologist, Carle Foundation Hospital, Urbana, IL Have you ever heard silence within a scream?

The deafening hum of pain being injected into a moment of loss.

During the beginning month of my fellowship, we had a trauma patient transferred to our ICU, after having surgery performed for his injuries. However, shortly after arriving, he became hemodynamically unstable. Instead of waiting for a cardiac ultrasound, my Trauma ICU attending, Dr. Marc de Moya, emergently (and instinctively) performed a bedside thoracotomy (i.e. cracked open the patient's chest). He manually removed the large blood clot from around his heart and started cardiac massage. For the first time ever, I watched someone squeezing life into another human being with their hand. Despite aggressive measures, however, the patient quickly continued to decompensate and he subsequently passed away. He was 21 years old.

The police officers were able to contact his parents (via license plates); they arrived and were in the consulting room. Dr. de Moya, the patient's nurse, and I entered the room, and upon sitting down, Dr. de Moya looked the young man's parents, and his accompanying twin sister, square in the eyes and said:

“Your loved one sustained some very serious injuries from his motor vehicle accident. We attempted to resuscitate him in the OR and at bedside; however, he unfortunately passed away.”

He abruptly stopped talking... and then pain entered the room.

I caught myself being transfixed on the mother; leaning on her husband's shoulders, hands anxiously hidden under the table... I was waiting for her response. Her noise. Her pain. Her tears. I was wondering what her next words would be... but she made none, she simply gasped. The father grabbed her closely, moaned “My God...” ... and their surprising quietness was interrupted by a scream... from the sister.

It was chilling; deep and underlining a heaviness that only a twin sibling could emphatically employ. A mother and father just lost their son... but she lost her soul mate... her womb mate; her first friend... and first roommate, and quite possibly her childhood annoyance down the hall. No one shared a more intimate bond with him, than she did; no one on earth carried the pain of his sudden loss... more loudly than she did in that moment.

I felt the wrinkles of her sadness speaking angrily as her screams faded into a feeling; into a silent hum. I felt the resentment she must have confronted for not remembering everything they did or all the little secrets she forgot that they once shared. I felt her wishing this was all a bad dream, a case of mistaken identity... a wrong patient sticker... a pause, followed by an apology from us for walking into the wrong room. I felt her needing no one to be anything to, or for, her in that moment... because no one could be what she wanted the most: her brother.

I remember this encounter vividly because I remember being... quiet. As she screamed and as his parents sobbed, I remember Dr. de Moya performing something he later explained to me as “stepping back.”

He told me, “In these moments, Moss, you aren't here to be a savior, a counselor, an explainer, a protector, or even a doctor. In these moments... you step back... and be what they need you to be the most: quiet.”

Quiet.

What I experienced that day wasn't the absence of sound, nor was it the echoes of noise somehow escaping into a distant metaphysical gateway... but rather me deeply reflecting... and challenging my understanding of what it means “to lose someone” ... during the silence of “being human.”