A peace that has no name.

To trust your care speaks volumes my friends, for a multitude of reasons, namely in my line of work and hope.

It was thirty minutes into my 12 hour night shift. I had barely even woken up yet, nor decided how to prioritize the care of the four other patients I had already assumed care of, when I heard the transponder go off. "This is rescue 33, we've got an ALS Medical Red, Unstable, male 27, intubated, pulseless ventricular fibrillation, ACLS protocol initiated, eta 5 minutes, do you copy?" I reached for the button, drew in a deep breath, and attempted to release the fearful quiver that rattled my soul before speaking, "Winter Park copies, notify us of any changes, see you on arrival."

My heart sank. My breathing became erratic. I put on my game face and did my best not to let the terror show. My preceptor looked at me and said, "Everything stops now. Plug in the code cart, page respiratory, and pull up some amiodarone." I pulled the giant red crash cart out of the wall and drew in one last normal breath, and thought, "this is it, this is why you are here." In the midst of drawing up the antiarrythimic drug, I feverishly pulled back on the plunger of the syringe with a nervous pressure. Upon withdrawing the needle from the vial, whilst trying to calculate and convert the milligram amount in milliliters in my head, the back pressure shot some of the drug in my eye............................fuck. My good friend and colleague looked at me, "Oh, Jess....," with her doll eyes flashing, wanting to laugh, wanting to tell me I'd survive this, she walked me to the eyewash station and doused me in water. Fantastic, the membrane of the eye is highly permeable and vascular...I might be feeling dizzy, is this nerves? Fear? Is my hair really this wet????????? Is the drug in my eye going to make me pass out?

His name was Billy. He was 27. He was my age. He had a normal life and a wife. On this particular day, he was playing softball with his wife and friends after work, drinking beer, trotting along the path of life. During the last inning, playing second base, a close game, he got down on one knee, looked at his pitcher of a wife, clutched his chest and said, "I don't feel so good." Billy stood tall, he swayed to one side, and folded like a stack of cards once fashioned into a fairy-tale castle complete with a mote. With an unexpected attack of fate, a defeat, Billy never got back up.

Rescue 33 pulled in and prattled off their account of what had happend, and what rescue effort they had performed. One of the medic's awkardly gawked at me, glaring me up and down, focusing on my general chest region. At first I thought it must have been the color of my face, now I know it was because I had sloppy wet tendrils around my face and my scrubs were soaked from my colleague dousing in me in water to flush the potentially dangerous drugs out of my eyes. Prior to arrival, the medic's had intubated the young man and establised intraosseous access. Thank god, because with all of the nurses and our years of experience with venipuncture, we could not establish iv access. There was no pulse to be felt.

Billy was blue.

I worked the code. I pushed the drugs. I analyzed the cardiac rhythms, vacillating between ventricular fibrillation and pulseless electrical activity from all the drugs I had given, trying to bring him back. Dripping wet from ear to ear, cheek to cheek, I shocked him, hoping not to become a bit of a code situation myself. I prayed. Yes, i prayed. I felt for a pulse, pushed more drugs..... still no pulse. I prayed again and then a strange calm settled and unnerved me all at the same time. I felt the shift. A peace that has no name. I believe this is the only way I can describe what it feels like when you feel someone's soul depart, it is an inherent, preternatural feeling, it is a privilige to witness......sometimes it happens so fast that other's never even notice. I hope I never lose this awareness.

After forty minutes, the doctor finally made the call.

Billy had a congenital heart defect as a child. He was healthy, just ran a marathon. However, we suspected the malformation of his aorta was ultimately the cause of his death.

The chaplain arrived. This was going to be a medical examiner's case, which means, the family can not visit the deceased, until the funeral. How awful. I asked the young female chaplain to pray with myself and the body prior to visiting the family, to break the news. I felt that if all we could offer the family, was to let them know we said a prayer, to acknowledge the passing from this life to wherever, it was better than knowing their beloved sat alone and cold on an emergency room stretcher. The young chaplain, lost, fearful of her own inadequacy to meet the grieving family's needs, said, "That's weird, i guess i haven't prayed with a dead body." Not anticipating that response, or in typical Jessica fashion, failing to think before I speak, "Congratulations, today is your lucky day......first time for everything."

I dimmed the lights and tucked Billy in for the last time.

I accompanied the doctor to the bereavement room. We conversed with the family and then we broke the news.The doctor left the room, left me with the family. There were wails, sobs, and people collapsing. They all looked to me for answers, for comfort, to tell them it wasn't true. I felt weak in the knees, the gravity of my weight and my heart aching almost gave way............ I cried with them, but just so subtly as to not have anyone notice. Sadly, I was forced to think, " I need to get back to the four other patients I have." This killed me, but no one else was going to care for them.

Lately, my dreams haunt me. What could I have done differently, if anything at all?

Sometimes we just have to suck it up and move on. There are those you can save, and those whom you can not. It is at these moments when one must never doubt the care they give, because you can only do your part. It took me 15 years to really understand what being with Billy that day taught me. Sometimes we are just here to bear witness. Sometimes we are meant to be safe harbor, a light that says: I am here. I cannot fix you but I am with you and you are not alone. Ultimately, there is always a bigger game being played, and more often than not, our part is trivial at best.