The Hardest Lessons

Matt Eisenstat

Medical school is difficult for many reasons. Everyone knows about the overwhelming volume of information and grueling hours. Every student with the intention of getting into medical school has heard about the crazy tests and the moments of self-doubt. I remember sitting in meetings after class in undergrad, listening intently as the medical students talked about their daily lives. I knew even before I came to USC School of Medicine Greenville that I had to put in hard work and long hours just to be competitive with my fellow students.

Over and over, I heard how difficult it was going to be and how I had better be passionate about medicine or I would never survive. Looking back on it, the studying isn’t that bad. The tests really aren’t either. Everyone in the class is going through the same experience. We support one another and push each other to work harder. If you put in the effort and stay excited about medicine then the medical school curriculum is completely reasonable. The hardest lesson I’ve learned so far in medical school completely blind-sided me. I was never prepared to deal with death.

I was on my third EMT (emergency medical technician) shift. We only needed two to take our certification exam, but I didn’t get enough patients in my first two to qualify. I wasn’t particularly happy about spending another weekend on the ambulance, but it was my first night shift and I was a little excited at the thought of getting an interesting case or a crazy trauma. The paramedics I was assigned to were young, funny guys. I think they were just happy to have someone else to joke around with on the ambulance. They quickly took to the role of teaching and tried to get me involved in any way possible.

The night started off slowly with only a few calls of questionable merit. The paramedics kept the mood lighthearted as we breezed through the first half of the night. Without warning, the night took a very different turn. At 1 a.m. we all heard the characteristic beeps on the radio followed by a quick blurb from dispatch on the computer, signaling a new patient was in need of help. From my position in the back of the ambulance I wasn’t going to crane my neck and see what the description of the case was. I didn’t need to. The joking and goofing around coming from the front seats quickly dissipated.

“Matt…” I heard the paramedic say with a voice somewhat shakier than I expected. “Matt… It’s a pediatric cardiac arrest… He’s two months old. Get ready.”

The summer before medical school I did absolutely nothing. It was fantastic. I knew that I was in the midst of the last extended period of freedom and no responsibility I would probably ever have. All I wanted was some time to relax and mentally prepare myself for the next four years. I’m the kind of person who likes to be overly prepared. Instead of just learning to change the oil in my car, I would buy Changing Oil for Dummies, Google a list of frequently encountered problems when changing the oil, and then mentally practice while watching YouTube videos entitled, Changing Your Oil: A Three Part Series. I’m only exaggerating a little.

The summer before medical school I bought three audio books: The House of God, The Intern, and How Doctors Think. If only there was a Medical School for Dummies textbook. I had a ritual. Every morning I would wake up at nine and immediately jump into my running clothes.  Once I shook off the morning fog, I would take off towards the nearby lake in my neighborhood. Once I got to the lake I would find a clear spot in the grass, lie down, and switch from my running music playlist to an audio book. Laying in the grass, soaking in the summer sun, I would reflect on what I thought was in front of me. I thought I was getting ready for medicine. I really had no idea that two months later I would be sitting in the back of an ambulance about to find out how wrong I was.

With adrenaline and a little fear coursing through my veins, I snapped my gloves as I had done only a couple times before. The sound of the ambulance engine went from a low hum to a deafening roar as the paramedic stomped on the gas. I sat there and watched out the back window as we weaved through traffic at ridiculous speeds. The sirens and horns of the ambulance broke up the monotony of the engine. It was the longest five minutes of my life. I remember hearing the protest of the gearbox as the paramedic slammed the ambulance into park from a rolling stop. I already had my hand on the door as I bolted out of the ambulance without a single inkling of was I would do next.

“Grab the suction unit!” the paramedic shouted, as I stood in the doorway, helpless. When I grabbed the little machine, I remember looking around and immediately recognizing the run-down apartment complex.  It was my first stop when I was shopping for apartments before school started. I was a few seconds behind the paramedics, but I could see the trail of first responders all headed in the direction of an apartment on the third floor. I sprinted up the stairs, blew past a hysterical family member, and dodged the group of meandering police officers.

The infant was lying on the floor only a few feet from the doorway. The grey color of his skin was ominous. I remember seeing three paramedics surrounding him. The cables, monitors, and tubes looked too large for his body. After a few panicked minutes, the decision was made to get to the ambulance. One paramedic grabbed the infant and continued chest compressions with the other hand as he sprinted to the truck. I followed close behind just hoping to be useful. With the mother crying outside of the ambulance, a group of five or six paramedics crammed into the back trying everything they could to revive the two-month old boy. When the decision was made to head to the hospital, a paramedic jumped out, looked me in the eye and said, “Well, I guess you’re going with them.”

I spent the entire drive to the hospital in a fog. I knew what was happening, but my brain refused to comprehend. My responsibility was to handle breathing for the infant. All I had to do was count and squeeze a bag. Count and squeeze. For 15 minutes I stared at the infant just trying to remember to count. I felt guilt for having no emotions, but I knew that my mind had just retreated. The lights were on but no one was home.

Once at the hospital, baby delivered to waiting arms, I stood, slumped against the counter in the Emergency Department atrium. As the adrenaline and numbness slowly left me, I began to finally piece together the previous two hours. My shell-shocked face must have been obvious. “Get used to it!” a nurse called out to me as she walked out of the boy’s room, snapping her gloves off in that way only medical professionals seem to know about. I couldn’t stand to listen to the sounds of the grieving loved ones so I walked through the double doors to the buzzing hallway. I drove home that night feeling nauseas, confused and shocked. Exhausted, I flopped into my bed. I pushed out every thought that tried to creep into my mind as I quickly drifted off to sleep. I was very thankful I didn’t dream that night.

The next day I woke up and went to the grocery store. The longer I was awake the more horrifying memories from the night before invaded the forefront of my mind. As I left the store, a red light caught me. The waves of emotion that had receded into the depths of my brain finally hit me. I held back tears as I smacked the steering wheel in anger and confusion. Only the honk of the person behind me reminded me to push down the accelerator and continue on through the green light. I don’t know why that moment hit me so hard. It might have just been the perfect intersection of looming memories and silence.

Death is an inevitable part of medicine. I knew death was a significant aspect of what I was signing up for. I just didn’t know that it was a lesson I would be introduced to so quickly. Looking back on that night, I now know that death is not a black and white experience. There is no single way to feel about it. There is no checklist of emotions that you go through. My only way of normalizing what I went through was to talk about it. I called my parents, I texted friends, I told everyone who would listen over and over again. I guess I just wanted to legitimize what I saw. I wanted someone to say, “Oh I saw something just like that and I feel the same way…” I was never really satisfied with the responses I got.

I wish I had some better words of wisdom or lessons to be had from my experience. If I’m being completely honest, this piece was more cathartic than anything else. To anyone planning on going into the medical field, don’t be scared of the things you’ll see in the future. Even from my brief time at medical school, I can already feel the sense of pride and accomplishment that far outweighs the bad. To anyone sitting on the outside looking in, know that the people in the white coats and scrubs are human. They grieve and mourn in their own way at their own time. That two-month-old boy had less time on this earth than I’ve spent in a single semester of school but the lessons he gave me are more valuable than any I could ever learn in a classroom.