The Imaginary Animals

Jenny Blair, M.D.
August 8, 2004

The resident standing next to me at the bedside was the humorless type. I hadn't seen him crack a smile all night. But there was nothing to smile about now, anyway. The scene before us was the most godawful thing I'd ever laid eyes on.

Our patient was at the tail end of a long night of emergency care. His heart had fluttered to a stop almost as soon as he'd arrived in the ER, though after a long and dramatic resuscitation it had reluctantly resumed beating. But he'd remained unconscious and unstable all night, in danger of arresting again at any moment. The dour resident beside me had come down to the ER hours ago from the intensive care unit, as part of preparations to admit the patient to the unit. But the patient was too sick even to be rolled down the hallway. The two of us scarcely left his side all night.

As a completely new doctor, I was out of my depth, but that is how you learn. Every time the patient "desatted" or "brady'd down" (in other words, when his blood oxygen level or heart rate dwindled) I frantically called for backup from my senior resident, who guided me through what to do next. Slowly I gained some insight into when to push fluids and when to give medications; what to panic about and what to let go.

Eventually, though, the patient's heart stopped again, and the ICU resident and I found ourselves surrounded by other doctors and nurses at the ER's second code of the night. It was terrible. Blood flew from the patient's mouth every time the resident did a chest compression, wetting his white coat. There was vomit on my arms and the arms of my senior. Despite our attempts to protect the patient's eyes by shutting them with a little gauze, they kept rising half-open. His weeping family had only just left the room. Eventually, we "called it." We went out to tell the family. Then I, as the intern, was recruited to fill out the stack of forms known as the Death Pack. The first page I signed was the death certificate.

Less than 24 hours later found me sitting at a little round table with my sister and three men we'd just met. We were at an art opening, doing what everyone does at art openings: eating grapes with Brie, sipping wine, and talking about art. Specifically, we talked about the art of one of the men, named Dan, who painted imaginary animals. What sort of imaginary animals? "There's one that's part horse, part dog and part human. It lives in a sleeping bag. Then there's one made of chocolate. It's called Chocolate Buddy."

A few minutes earlier, my sister and I had been privy to a little scene at which a flustered administrator bewailed an inexplicable electronic beep from a piece of audiovisual equipment in a room where an art lecture was about to be given. If the beep weren't muffled or silenced, the lecturegoers would hear it every time it went off, about once a minute. I studied his face as he rushed around seeking solutions ("This is an alarm. Call Security. Maybe if we put some Band-Aids over the speaker?"), marveling at how upset and worried he was.

I was jet-lagged. I had just woken from a day's sleep after that gruesome night shift, which had gotten even worse when I was faced with the task of collecting state evidence from a teenager who had been raped. Some overlayer of conscience and convention seemed gone. Though I've certainly fretted over similar things in the past, it now struck me as ridiculous that this professor was agonizing about a beep. Equally bizarre seemed the posturings of all of us guests nibbling asparagus and dried fruit in an airy museum. Next to the emergency room, it all seemed so inconsequential -- the black-clad immigrant stewards refilling the elegant platters, the coiffures of distinguished old ladies, the framed works of art and their carefully written captions on the walls beside them. I could only imagine what the grim ICU resident would have made of all this.

Yet I think these things were on equal footing with what he and I did last night. I've long thought of doctors as enablers. It is our business to remove the obstacles of ill health, to keep people alive and healthy long enough to bring them to moments like these, where the highest expressions of experience can be admired on walls, where important things can be discussed and taught, where the human psyche can move forward and the moments take place that make life worth living. That goes, of course, not only for art, but also for joy in one's work, for unforgettable times with one's family, for hikes and dances, road trips and impassioned speeches and creations all one's own. Granted, the Chocolate Buddy may not be mankind's most profound articulation of its place in the universe. But, as Voltaire said in a somewhat different context, "I disapprove of what you say, but I will defend to the death your right to say it."