Finding my place.

On the first day of my internship, at about 8:00 in the morning, I was paged to the CCU. There a patient who was assigned to my service was undergoing resuscitation after cardiac arrest. Running after my resident, we arrived at the bedside of an 89-year-old man with end-stage congestive heart failure. The bed was surrounded by cardiology fellows, nurses, residents, a ventilator, crash cart, and ECG machinery, and the floor and bed were strewn with paper, ECG strips, discarded tubing. I watched as we shocked the patient repeatedly; tried four times to get a central line in; injected pressors directly into his heart; stuck the femoral artery for blood gases; and carried on chest compressions for over an hour. Finally the cardiology fellow called the code. Leaving the patient naked and covered with tubes, paper, and bloodstained sheets, we left his bedside. The patient’s wife was seated outside the unit. We all walked past her, to get back to the work of the first day. I do not know if anyone spoke with her to explain what happened. Certainly no one explained it to me. This patient’s death was the first I witnessed. My colleagues were committed to trying to save his life and we applied every technology at our disposal to achieve this end. There was no sense of uncertainty or ambivalence about what we were doing. Our motives were simple and clear: prolong life. The primary emotion after the code was one of both discouragement and determination—we had failed to save this life, but next time we would know more, do better, and have more knowledge to help us—next time we will get it right. My own emotions were a confused tangle of feelings of complete inadequacy and guilt—I should have learned to put in central lines as a medical student, I should have known how to conduct CPR, I should have arrived earlier in the morning, I should have come in the day before to get to know my patients. The principle of respect for life, that all life—no matter how diminished by disease or illness—is precious, and that the medical profession’s only raison d’etre was to use all tools available to prolong it—was such a fundamentally held assumption that it was not (at least consciously) questioned throughout all my 9 years of training. This patient died 31 years ago in July 1977. I have been carrying him with me ever since. Three months later, my grandfather, Frank Meier, died suddenly. I adored my grandpa and learned to love ice cream and gardening and to understand that all people were one, from him. He was a socialist in his youth and instilled firmly held values about service to others in his two sons and three granddaughters. He came to visit me in September of my internship, and during his visit, asked me what it meant that