My Thoughts Almost Killed Me

My wife once asked how we do it in the ER, to be there for everybody’s worst day, and sometimes for their best.This was my worst day, and almost my last.

I had left a lucrative job that I loved to move west to be closer to extended family. I suppose I started to worry when one of the three new hires was let go about 2 months after he started. I began to fear I would be next. I had my one month review after three months of employment, and in the review there was a complaint from a nurse about me. When they reached out to the nurse who had complained, she stated that we got along great and I was easy to work with. Shortly after this, I was informed I had a case from August in peer review. After this process was completed, it was rated as “improvement needed”, despite submitting literature showing I had followed the standard of care. Early in October, there was a cardiac alert that had some issues and an angry cardiologist blamed me for not being paged. This triggered an extensive review committee including hospital safety and administration, nursing, and EM group site director and administrators were brought in to review my deficient care. In the end, I was cleared when a unit clerk took responsibility for not paging cardiology immediately per protocol due to confusion with the new EHR. 

Never had I experienced problems with administration in my career like this. It seemed like a series of unfortunate events. After this bombshell, I stepped on a landmine. A case from early September had triggered yet another peer review and while any prior review process would have given “improvement needed” this was of course also given “unacceptable care” by my new group. At this point, a well-meaning board member explained the process to me and noted that while it seemed like bad luck, the next unacceptable care might very well lead to termination of my contract.

In September, I took care of a patient who had recently been seen for back pain and diagnosed with herniated discs.  On this, her 4th visit, I looked further and through a series of tests including blood work and imaging diagnosed her with cancer. I held her hand as I talked to her about the diagnosis, and admitted her to the main campus where the oncology service was located. She passed away 2 weeks later, and her partner wrote a letter to the CEO of the hospital system complaining in general, but specifically about me. This also seemed to blow over, but after being told my contract was now at risk, I started going to work feeling like I was walking on eggshells. I started thinking each patient could be the one that triggered review, and ultimately termination. 

So the straw that broke the camel's back… In early January I treated a 19 year old for influenza. She had been seen and diagnosed previously, and review of her records showed multiple x-rays and even a CT soft tissue neck hours before at a prior ER. She was positive for influenza A and had multiple prescriptions. These cases are tough, because they are expecting something new or different from the new visit and she already had every reasonable treatment. I gave her a couple of treatments in the ER and she felt better then discharged her home.  33 hours later she came back, in respiratory arrest. To this day it seems like just the flu, but she ended up on life support and ultimately passed away. They of course blamed me and complained. They were devastated and so was I. I had a child the same age, and I was consumed with thinking about all the milestones her parents would now be missing out on. I was depressed and despondent about it all, but still was expected to work and somehow be ok. 

My scheduled review was just days later. They were concerned, because I was clearly depressed and voiced their support of the case noting it had already been reviewed and I had done everything correctly. One of the reviewer's stated that while they were very sorry about the case and stated support, the culmination of all of the above would likely lead to termination. The other reviewer quickly noted that this was not a guaranteed outcome, but was indeed possible based on the board's decision at the next meeting. I thanked them for their honesty. At first my wife and I talked about it, and it was reassuring to think that I had other options if I was let go. My previous job was more than happy to pay for me to commute back-and-forth as they continued to be short staffed. I went back to work that same night grieving, but comfortable with the likely outcome of termination.  When I got home in the early morning hours, I was still devastated. I cried for the girl and her family. I cried myself to sleep and woke up 2 hours later in so much pain.

This next part seems surreal at this point. My wife left with her sister because I appeared to be ok with a soccer game playing and a book by my side. I distinctly remember feeling an overwhelming darkness and pressure as I sat alone with my grief. Suddenly, I just snapped. I grabbed what I needed and left. I drove up into the foothills where I had done so much mountain biking, and wrote a few last texts to my wife. I took a handful of pills with the final thoughts at least life insurance would take care of her. I felt like I was a burden to my family that I loved so much and they would be better off without me. At this point a police car showed up on the mountain road, but just pulled off to the side clearly watching me. Thinking this was weird, I began to drive back to town to avoid confrontation.  Suddenly my wife and sister in law showed up on the dirt road. I could not face my wife at this point. I knew she would be better off without me, so I continued to drive past them. A little further down the road, a sheriff's vehicle attempted to block the road. I used my four-wheel-drive truck to go around him through the snowbank. This was the start of a low speed pursuit, with multiple police and sheriff vehicles following me. At one point I pulled over and asked them what they wanted, and I clearly did not want to talk to them so I drove away again. My lack of cooperation caused them to arrest me and put me in jail. This was nearly the perfect assist to my attempt as they placed me on a suicide watch with no medical monitoring. The last thing I remember was thinking "this is it '' and lying on my stomach on a concrete bench; I closed my eyes one last time.

After multiple phone calls from my wife and sister-in-law stating their concerns, somebody did check on me shortly before 3 AM in the morning. According to them, they found me taking my very last breath. I was pulseless and they began CPR. Medical records showed they did 15 minutes of CPR and used a defibrillator before I had return of spontaneous circulation, and my presenting labs were a lactic acid of 15, and BUN and creatinine of 68 and 3.68. I had slightly elevated troponins, a potassium of 6.0 and GCS of five with an EKG showing inferior infarct. Prior to intubation I had been moving my extremities with decorticate posturing. In short, the prognosis was grim at best. Doctors advised my wife that my family should be notified that death was most likely imminent. 

I have very few memories of the next four days in the ICU. What I can remember clearly is that when I woke I was surrounded by loving family who were there in a non-judgmental fashion for me. 

We were all in shock that this happened, especially my wife. I have spoken to friends and close colleagues about my experience, and they were all universally shocked that it happened. Nobody could picture me doing something like this. Looking back, I still find it hard to believe that I could have ever gotten to that point. Somehow, I believed that I didn’t have options and that I couldn’t ever feel better. Each day I am acutely aware of the value of life, and I'm grateful to have another day to appreciate. 

Some of you may have lost loved ones, friends and colleagues, or maybe you’ve felt this way. While I can't actually speak for them, from my experience they are sorry, and would go back if they could.  At the time, they may feel like an excruciating darkness and pain won’t go away unless they leave this life, but they don’t understand that it can often get better. I have a chance to tell people it can get better and teach them how.

You are not alone. We are in this together!