Op-Med is a collection of original articles contributed by Doximity members.
Many years ago, my colleague’s voice, through a plastic office phone, told me that EMS found you lying on your mother’s bed — small, still and not breathing. His disembodied voice continued on to flatly tell me that by the time you arrived at the hospital, you had been in full cardiac arrest for 20 minutes. I heard myself saying, oh and mmm between his sentences as I waited (impatiently) for him to say, but…you were stable now, but… you would be going home soon, and… I’d see you in clinic for follow up in a few days.
He never said those words, though. Instead, I learned that you had died in the hospital early that morning just before sunrise. Just before sunrise? At just before sunrise, I was just waking up.
Which baby, I asked urgently. What’s his name? But, even before he told me your name, I was already logging into our electronic health records to search for your name. When I found you on our system, I read my note from five days ago — quickly, first, to remind myself who you were and who your mother was, then deliberately, then slowly. Then, obsessively. By the time my colleague told me that your diagnosis was sudden infant death syndrome (SIDS), I had already reread my note three times, four times, five times; I could pretty much memorize my medical note by heart.
I obsessively and repeatedly did forensics on my chart note, mindlessly saying “uh huh” to the voice on the other end of the phone while neurotically combing through my documentation, examining and analyzing every sentence, every word, every bullet point. I was looking for clues. Clues for something I might have missed. Clues that could point me towards why this happened. I fixated at the Assessment, and I replayed every part of the Physical Exam. I replayed every moment of that visit, replayed my words to your mother. I saw you laying on my exam table, saw myself carrying you to your mother to watch and help her with breastfeeding, saw all of us delighting at how well you were latching on and feeding. I heard myself giving your family safety and anticipatory guidance, telling them to put you on your back to sleep, in your own bed, and alone without any fluffy blankets or cute stuffed animals. I saw myself opening the door and telling you and your mother that I was super looking forward to seeing you back next week. Because, you know, you were just so cute. Your mother had laughed at that. I remember how happy she looked.
When I hung up the office phone, I was appalled that life seemed relatively normal still. The medical assistants were starting to arrive. My pediatrician colleague had come in and was scrolling through his list of patients for the day. But, I kept imagining flashes of ghastly images of your dark home, you on a queen bed, with blood coming out of your blue mouth and your limbs hanging limply from your body, your tummy not rising up and down, your face a grisly grey. I was hearing your mother screaming ohmygod ohmygod, your father shouting come on come on breathe, and your three year old sister with eyes wide open held in the arms of your oldest brother who stood arrested nearby watching this 3 a.m. nightmare.
In between visits throughout that day, right before I knocked on the exam room door, I made a concerted and conscious effort to push away the flood of thoughts that pressed against my mind as I vowed to be even more present and more empathetic for each family I would see that day. During lunch, to avoid letting my mind slip, I focused on finishing up my charts; I was so efficient I had an extra fifteen minutes to spare before my afternoon session began, and I used it to read a recent paper on Enteroviruses.
Finally, nine and a half hours after the phone call, a full schedule, twenty six visits, and twenty-six completed charts later, the sun had set, and it had become dark outside. Most people in the clinic had left already, and it was just me and a few coworkers at the front desk finishing up billing in the building. I headed over into my office and sat down at my desk. Contemplated clicking on the “Patient” icon. I clicked it. Then, I deliberated over typing in your last name and your first name. I typed and slowly pressed “Find”. No records found. I thought I must have mistyped, so I typed again. This time with one finger. Clicked “Find”. Nothing. I typed in the first two letters of your last name and your first initial, which brought up a long list of patients. I scrolled down to where your name should be — nothing. I scrolled again, wondering if somehow I had forgotten the alphabet.
Then, I realized what had happened — you had been taken out.
You no longer existed in our active patient records.
And, it was at that moment, in the privacy and space of my own office, while staring at the words — No records found — that I finally came to realize the absolute fact of it. That you had died that morning. That your sister and brother had lost a sibling. That your mother and father had lost a child. Their child. Their baby. And yet, despite the magnitude of that, only a few people in the world would ever know that you existed. I was one of them.
I thought back to that morning so many hours ago, when I walked into clinic on a beautiful Monday morning, how it all began so nonchalantly with one of the girls from the front desk coming into my office telling me, one of the other doctors wants to talk to you, should I transfer the call?
I put you on replay. Put myself on replay. Put that half an hour visit with you and your family on replay. Again and again. The first and only time I met you. Your name off our system. The first and last time I met you. Your name coming up with “No records”. My thoughts were on a never-ending loop, repeat-rewind-replay, repeat-rewind-replay. Again. And, again. It just wouldn’t stop.