Beep! Beep! Beep! “This is EMS bringing in a code three cardiac arrest. We have a toddler who was found unresponsive by parents. CPR is in progress. ETA five minutes.”

The hairs on the back of my neck jumped as I listened to the ring down. A wave of anxiety and fear coursed through my body in anticipation of what would soon roll through the ED doors. No matter how many times I mentally prepare myself, organize my team, and establish the tools necessary for resuscitation, nothing truly prepares me for the emotional toll that ensues after it’s all done.

The child was barely a year old. The paramedics rushed this small, lifeless body into our resuscitation bay, and we immediately descended upon her with full force and hope to bring her back. After an hour of throwing the kitchen sink (and then some) to revive this child, our efforts were ultimately futile. I called the code. Time of death 10:56 a.m.

After the adrenaline wore off, an air of sorrow and lament settled among everyone in the room, including me. I asked everyone if we could share in a moment of silence for this life that was taken too soon. I felt defeated and hollow inside. My emotions were frenetic, but I knew I had to compose myself to do something more difficult than calling the code.

I walked out of the room and immediately met the eyes of the father, who had already been peeking through the door to know whether his child was going to make it. Upon seeing my face, he knew. He collapsed to the floor and sent out a wail of anguish that shook the entire emergency department. Fighting tears myself, I picked him up and walked him to a private room to tell the rest of his family the news. I remember slowly staggering out of that room, thinking to myself, “You can’t gas out now. This is only the first hour of a very long shift.”

Three Tactics

As emergency physicians, all of us have had, or will have, cases like this in our career. Over the few years I’ve been in training, I’ve learned some tactics that help keep me mentally and emotionally intact after a difficult case:

1. A moment of silence: Consider taking a moment to recognize the life that was lost. As emergency providers, we love to highlight our saves, but we should also take time to acknowledge the lives we can’t save.
2. A team debrief: After long resuscitations, gather everyone involved in the case to share what went well or didn’t go well and to share how they are feeling. I find it provides an emotional release and serves as a powerful platform for the team members to provide feedback to one another.
3. A moment for yourself: I find it emotionally difficult to walk away from an intense code and directly move on to see another patient with a minor chief complaint. I know I can’t provide the best care to my next patient if my mind and emotions are still wrapped up in another. Take a moment to reflect on what has happened and find time to compose yourself. This will not only benefit you but also the next set of patients you care for.

I entered medicine to save lives, yet my experience in training has provided the harsh lesson that they can’t all be saved.

As physicians, we serve as beacons of hope during times of crisis for patients and their families. That honor also comes with the burden of delivering the sobering messages of death and dying. In my humble opinion, this is the most difficult part of being a doctor.

Despite what you may think or may have learned in training, there is never a perfect way to deliver bad news. The only thing you can hope for is that you communicate with respect and empathy, dignifying the life that was lost.

Dr. Thomas is an emergency medicine resident at Highland Hospital in Oakland, California.