No one says the word “quiet” in a hospital, and that is a lesson we all learn quickly. If by mistake a new hire or student says the ‘q’ word, staff will spew expletives and glare accusingly at the person every time something goes wrong for the rest of their shift. All hospital staff seem to share this surprising superstition, from nurses to residents to techs. Moments of quiet in the hospital are treasured, as they usually mean workers get their breaks, sip on dregs of coffee, or reply to a few text messages.
There is also a dark and heart-wrenching quiet that I learned about quickly as an x-ray technologist. This quiet floods the hospital when a child is lost. The first time I experienced this quiet was when I was a student working on the swing shift and an automobile collision trauma came into the ED. A drunk driver slammed into a vehicle after crossing several lanes of traffic. The adults involved in the collision appeared to be physically okay, but the 4-year-old little girl arrived in critical condition. The EMTs arrived with one of them performing CPR on the child and the other telling us she had lost a lot of blood. As a student, this was my first exposure to seeing anyone receive CPR outside of training videos and it was incredibly unsettling to see it done on a child. I remember feeling like they must be compressing too deeply because her chest caved in so unnaturally. I began mentally preparing myself to step in if someone needed a break from compressing, while also listening to the physician to see if he would be needing any x-rays. As x-ray techs, we are required to clear out the room during our image exposures, even in high-stakes traumas like this one. We have to be loud, clear, and authoritative to tell everyone to step out of the room so that we don’t contribute to any additional care delays outside of the few seconds for image exposure. This trauma would not need any x-rays because unfortunately the little girl had lost too much blood and her vitals refused to stabilize. The response team alternated performing CPR and attempting life-saving measures for 45 minutes before the ED physician finally called her time of death. Then came the sound of her mother crying and screaming after losing her child, which is unforgettable and utterly inconsolable.
The aftermath of losing a child anywhere in the hospital is palpable. It is quiet, but in a painful way. During this time you might find the otherwise steely physician or charge nurse silently crying. Workers become vacant and expressionless, continuing to work because that is generally our only option. It feels like a wave of ice sweeps across the department and spreads throughout the hospital. Debriefings and huddles related to this trauma response will occur, but there is always time allowed for this first, where staff process heavy emotions privately first. This is another type of quiet that we do not talk about in hospitals, but we all know to respect it and allow space for it.
After several years of working in diagnostic imaging, I am now returning to school to become a physician assistant (PA). My years of experience have better acquainted me with the shock factor of traumas and I understand now more than ever how essential our life support skills and training are. In my experience, being prepared is the best antidote to fear or shock. It is worthwhile for medical students to volunteer for CPR whenever they can, have a go-to song that will keep their compression rate on track, and actively participate during their life support training sessions. Basic life support should be considered as when we will use these skills, not if we will use them. It is important for students to commit life-saving skills to memory. This may sound like an obvious recommendation, but hospital orientations often include dozens of learning modules for staff and students to learn. Some of these will feel redundant or common knowledge, but life support recommendations are known to change periodically. Students will need to fight the inclination to skip through tutorials to get to the test. We must remember that while these skills are necessary in the hospital, they also may come up in our personal life. Recalling the steps to clear an infant’s airway, for example, is a skill that will serve anyone who has young children in their life.
In addition to practice and repetition of skills, there are proactive actions students should take for their mental health to prepare for saving lives. Medical professionals should whenever possible prevent burnout and emotional fatigue by taking our breaks, using our vacation time rather than cashing it out, staying physically active in whatever ways we enjoy, and considering reaching out to hospital-provided counseling services when needed. Participating in team debriefs after traumas, even if you think you have nothing to say, is a good idea for anyone in medicine. I have been surprised in the past by how helpful it is to hear that others feel the same way we do. At some point or another, we all seem to struggle with survivor’s guilt, grief, shock, anger, depression, apathy, or religious turmoil. We must protect our mental health as fiercely as we protect our patients, because our mental health ultimately will impact our patients for better or for worse.
The privilege to learn life-saving skills comes along with our work in healthcare. The ability to masterfully apply those skills with calm confidence only comes with dedication to your craft. As a final piece of advice, remember to respect when a hospital becomes quiet.