1. Bloomfield, Michael M. MD


A retired physician recalls how a nurse helped him out of a predicament as a new intern.


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Medicine was my first rotation as an intern. At University Hospitals of Cleveland, the medicine rotation had a particularly intimidating reputation and a red-hot I was not. I was terrified.

Figure. Illustration... - Click to enlarge in new window Illustration by Annelisa Ochoa.

On morning rounds every day our entourage of physicians, nurses, and students would go room to room discussing each patient. I can still see the open door to Mrs. Finkelstein's room near the morning sunlight at the end of the hallway. Mrs. Finkelstein was old and was dying. And every morning when we walked in, her husband was sitting there next to the bed, holding her hand. He told us regularly how many years they had been together. We each dreaded being the one on call when she died.


Call was every third night and was grueling. One night when it was my turn, my senior resident pulled me aside after sign-out rounds and said that Mrs. Finkelstein would probably die on my shift. I wasn't ready. In medical school they taught us everything about keeping someone alive, but no one ever told me what to do when a patient dies. I had never pronounced a patient dead before. No one had even explained to me how to tell if someone is dead.


He could tell. He said take your time. Be respectful. Be methodical. Be confident. Appreciate the meaning of the moment for the family. Listen to the heart, look for respiratory effort. Talk straight. Stay for as long as the family needs you. And then he left me in charge of the floor for the night.


Call was mayhem. Always. The night was spent frantically admitting patients, taking histories, doing physical exams, checking labs, writing orders, starting ivs, talking to family members, flaming broth tubes for blood cultures, doing manual white cell differentials, and the 10,000 other things that an intern had to do in those days on a medicine rotation at University Hospitals of Cleveland preparing for the assault at morning rounds. Sleep was never really an option.


Somewhere in the middle of the night and the chaos a nurse came up to me with that look, and I knew. I wasn't ready. She could tell. She came with me.


He was there, holding her hand as always, eyes wide. His whole world depended on me. I walked in quietly, looked for respiration and listened to her heart for a long time. Nothing. I took the stethoscope out of my ears and looked at him with genuine compassion and said, "I'm so sorry." He looked down at the bed, dazed, and we stood there in silence, sharing the weight of the moment.


That's when it happened. Mrs. Finkelstein breathed an enormous sigh! We all froze. I was mortified. Mr. Finklestein looked at her-looked at me-looked at her-looked at me.


"What was that?!" he said. I tried to look calm. "Well, is she dead or isn't she?" he yelled. Inside, I was reeling. What the hell? Is she dead or isn't she? Four years of medical school and I can't tell if someone's dead?! Time froze-the moment remains suspended in my memory still. I don't know how long we stood there, but it felt like such a long time.


"After a person dies there are last gasps," the nurse explained to him quietly as if it came from both of us. "Not unusual." I nodded authoritative agreement, expressed my deepest condolences, stayed as long as I possibly could, and went back to the 10,000 things. And I have remained indebted to that nameless nurse of the night ever since. And to so many others throughout my career who quietly saved me.