PATIENTS WHO NEVER LEAVE US
Kelsey Van Housen

We hadn’t been able to save her. 

I kept my hand on her forehead as we drained the blood from her body, my small desperate act to comfort this teenager gone too soon. I felt her face go cold beneath my hands and I watched her color dissipate into the cold stainless operating room.

The room was somber, silent, still; her neck still bearing the ligature marks that took her life. 

Her family had written a statement to be read in the operating room before we began. 

“Hello. My name is Marian.
I am a daughter, a sister. 
I love my friends so much it hurts.
I am a volleyball player, an animal lover …”

The room full of medical professionals stood silent, trying not to cry. The reminder of humanity made it hard to hide behind the safety of scrub caps and white coats. 

The reader continued on.

“I used to love volunteering in the animal shelter,
and I would spend my allowance on Christmas gifts for kids in foster care. 
I would be so proud to know that I’m donating my body, so don’t f- it up.”

A moment of silence. 

Her words had put all of us in a trance. 

But medicine never waits, and in another instant, the spell was broken and the surgery began.

Transplant surgeons from four major academic centers swarmed strategically around her body, skillfully wielding their sharps against her glittering insides. Behind them, rows of residents and trainees jockeyed over their shoulders for a view. 

Moments prior this room had been as solemn as a chapel for the grieving; now it was a buzzing, vibrant fountain of life. Moving methodically, the surgeons expertly isolated her organs from top down, one by one. As each precious jewel was freed, it ascended from her body on wings of blue rubber, cradled in two protective gloved hands. The feeling of awe in the room was palpable. 

Each salvaged gift was of matchless worth to the dying person waiting to receive them. And these weren’t just any organs, these were pristine, glistening, teenager’s organs, who hadn’t yet seen decades of wear and free radicals. I had to catch my breath as her perfect, healthy, high school athlete lungs were lifted fully inflated from her chest, all beautiful and full and pink, glistening in their glory like the gold they were worth. Hope incarnate. 

As soon the last vessel feeding it was tied off, each jewel was properly packaged and that team would hurry off to their waiting helicopter or ambulance standing ready outside our hospital’s doors. As the gifts flew off to their recipients, the numbers around the table dwindled.

In the final handoff of this great relay, I scrubbed in with the team taking her last precious kidney, retracting as they briskly dissected that shiny perfect bean from its original home in her left retroperitoneum. As they packed their nephric gift in its icebox, they stripped their gloves and imparted thanks, leaving me to close her great cross-shaped abdominal incisions. 

The room had transformed again. Now that the teams of academic surgeons and their magic organs had left us, the buzz of excitement died down. The glitter in the air settled, leaving just a few of us around her table. The magic was over, her life source gone; she was now once again the girl we hadn’t been able to save. 

She had been a trauma code, and we had met her in the resuscitation room of the ER two days prior. We had given her the best that medicine had to offer and had kept her alive just barely, but when the brain scans came back, we knew we hadn’t been able to save her. Her family had made the heroic decision to donate her organs, giving life from where she had lost it. 

I will never forget the scene where she had been wheeled to the OR for her donation.

 Her transfer to from her far corner bed of the pediatric intensive care unit was like the procession of a saint during Holy Week. Her weeping family followed behind, the hallway walls flanked by dozens of hospital staff there to honor her. The brash hospital lights had been replaced with colored twinkle lights, making it special in a way only a pediatric hospital could. 

And now she was here, on the OR table, her blood drained and organs gone. I put my hand on her side and took a deep breath. 

I gave her the best I could in that moment—my best suturing for closing the cross-shaped abdominal incision. The tech and I gently wiped the chlorhexidine from her body, as if we could cleanse her from whatever pain had brought her here. As the circulating nurse zipped her up in that anonymous white bag, I smoothed her hair, tucking it behind her left ear. 

My job as a medical practitioner was now over, but I couldn’t stomach the thought of leaving her. I kept my hand on her bed and somberly accompanied the transport tech to the morgue. 

We laid her carefully in there next to the other bodies, and I grasped her hand one more time. What was I hoping to communicate in that touch? “Thank you”? “I’m sorry”? 

“I wish we could have done more.”

We then walked away, leaving her alone in that cold basement, and I was left alone in the bleak hospital hallways with my thoughts. My shift had ended hours ago, and I had no role to play and therefore nowhere to hide the upended feelings inside of me. 

      ***

We all have the patients who never leave us. She is mine.  

I think of her often, especially when I leave the hospital in the wee hours of the night, in my long walk to the far corner parking lot. 

Her memory causes me to pause, re-orient and remember why I am here. In her final act of life, she gave of her body, gave her all. Through the gift of her organs, she brought rebirth to dozens. 

Her memory reminds me of the gifts we possess in our hands—knowledge and tools for healing, as well as the honor of caring for people. Her story begs the necessity that I always give my best. I hadn’t known her in life, but her death was a defining moment of my medical career.

These patients who never leave us serve as silent reminders of our purpose. 

May these lives we couldn’t save make us better.
May these stories that broke us make us more whole.
May we always strive to give our best to those entrusted in our care. 

Kelsey Van Housen is a third-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. She is also a physician assistant (PA), and this narrative is about a defining experience in her first year working as a PA with a pediatric surgery service at a Level I trauma center. Outside of medicine, she enjoys art history, meeting dogs and spending time at the ocean.

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