An expression of shocked grief, a phone thrust into my hands, and the words falling on disbelieving ears: "She won't be at work tomorrow. She's dead." An accident had cut short the life of one of my interns. The story was tragic: last day of vacation, bags packed, a friend waiting at the hotel, and one final jog before a long flight home. A speeding car, a distracted runner, and an unfamiliar city combined to produce massive injuries; an ambulance rescue; intensive resuscitation; respirator support; and, ultimately, recognition of brain death. With her stunned parents at her bedside, the machines were stopped, and she left us.
She stood out among the housestaff. Her appearance was striking, yet she had an unassuming warmth and a palpable vitality. A hint of Europe flavored her speech, revealing her immigrant past and adding a touch of the exotic to her all-American looks. Always excited about working as a physician, she defined "joyful" for all of us. At the hospital, everyone liked her. Her success as a role model was never doubted by anyone who met her. No one was more alive and more incongruous with the idea of death.
As I hung up the phone, I knew that I needed to tell everyone about the tragedy. The bond created by the long hours of doctoring side by side makes housestaff a unique family; as the program director, I am the head of the family. They had to be told quickly. Whispered rumor was not the way to find out. Although I was nervous, I knew I would find the right way to do this. After all, I am a physician, experienced in breaking bad news.
We called an emergency housestaff meeting for 5:00 p.m. Find a room! Everyone had to be there, no exceptions. The chief residents did their job well, and as I sat on the conference table, the room quickly filled with tentative, concerned residents. What were they thinking as they waited and quietly talked among themselves? Did they think that they were in trouble? No. They sensed that this was about a tragedy. They knew. After all, they too are physicians.
When the room was full, I told them, "We are a close group. We all care about each other very much. Today is a painful, sad day for us. Klaudia died today in Madrid. It was a terrible accident. I'm sorry." There was shock and pain in the 100 eyes riveted to mine as each word brought home the tragic reality. And then there was silence, a long silence. Tears. Hugs. Caring for one another. Gradually, in small, tight groups, we left to find private places to think, to cry, to grieve, and to try to understand. It was so clear that calling the group together was the right thing to have done.
The housestaff came together as never before. Although they were already veterans of encounters with death, this was very different, so personal and so close. The psychological defenses that work so well in the clinical setting offered no protection from this devastating loss. The evening after Klaudia died, many residents were out walking the neighborhood streets until late at night. They were in pairs and in small groups, talking, grieving, and trying to make sense of this tragic loss. There were formal support sessions to help people deal with their feelings, and although these meetings helped, the greatest support came from the support of one another.
The memorial services, funeral, and burial were all rituals to help us accept the unacceptable. The pain and emptiness will lessen with the passage of time. Already a new group of interns has arrived. However, we will not forget that we lost Klaudia, one of our own, in springtime.
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