I see dead people

October 6, 2006
Steve R. Edelstein, MD
Steve R. Edelstein, MD

As an emergency physician, this doctor expects to encounter death. But his most unsettling incidents occur outside the ED.

It's a strange life we lead as physicians, when we have such close contact with the dead and dying. In a way, it's akin to being a soldier or a mortician. Our natural fear of death diminishes every time we perform CPR on yet another 95-year-old nursing home patient who comes into the ED triple-zero, and without a valid DNR. And yet there are still some cases that leave me in awe of death.

For three years I worked in the ED of the Arroyo Grande Community Hospital in the lovely central coast of California. In this fabulously lush area, even commuting to work is a pleasure. There's a beautiful stretch of Highway 1 near Pismo Beach that I passed several times a week. On my way to a night shift, I got to watch the sun set into the Pacific.

As I made the drive one evening, an accident stopped traffic. I left my car to offer assistance to the EMS personnel. Three ambulances, a fire engine company, and several police officers were on the scene. A car had crossed the midline of the highway and caused a small pile-up. An elderly man in one car was dead, apparently from a head or neck injury. A woman from the second car was lying on the highway surrounded by first responders. She looked to be in her mid-40s and was yelling in agony, complaining of pain on the right side of her chest and trouble breathing. Listening with my stethoscope, I heard decreased lung sounds on that side, but there was no crepitus, flail chest, or evidence of a penetrating injury. Her blood pressure and oxygen saturation were normal, and she had no obvious tracheal deviation. The EMS personnel had given her oxygen and put a C-collar on her. I helped them roll her onto a backboard. Borrowing a phone, I called ahead to my hospital and told my partner that I suspected a pneumothorax, and warned him that I was going to be late for my shift.

Kneeling in the median, with her family looking on from the shoulder of the highway, I realized that it was one of the hardest things that I have ever had to do. Eerily, the girl didn't seem to have a mark on her. At that point, I didn't think there was much I could do; she had probably been lying there for 20 minutes, and the likelihood of reviving her now seemed very, very low. I pronounced her. I may have closed her eyes; I don't remember. I did ask the medic for a blanket to cover her. Feeling sick to my stomach, I got back in my car and drove to work.

A gruesome accident, two dumbfounded doctors

A few years later I moved farther south, working for a group that had a contract with a small hospital in Santa Ynez. It was a very small hospital with a four-bed ED, and once or twice a month I drove up for a 24-hour shift. To get there, I drove west on a two lane highway that winds through San Marcos Pass and the Cachuma Lake Recreation Area into wine country. On the way back, I'd come over the pass and get a view of the ocean that took my breath away.