We did everything we could.

Yesterday was a very difficult day. 

I worked a 12-hour shift in the most acute area of our emergency department.  A few hours into the shift, we got a call from an ambulance bringing in an older man with abdominal pain.  It was assigned to one of my rooms.  I shrugged, got all the supplies ready in the room for starting an IV and drawing the typical abdominal pain labwork, and continued drinking my coffee.  I saw the ambulance pull up to the bay from my desk, and rose to meet them.  They were walking faster than a crew typically would for a belly pain. 

"This guy's in V-tach, and I couldn't get a line in him," the EMT said as they roll into the room. 
"Some simple belly pain..." I said to myself as I ran down the hallway to fetch the crash cart.

The gentleman was awake and talking to me, despite his heart's arrhythmia.  As we moved him from the ambulance litter to our stretcher, his rhythm converted, and we all breathed a sigh of relief.  We attached him to the defibrillator pads and monitors, got an EKG, got two IVs started, drew the blood work, started anti-arrhythmic drugs, shot a chest x-ray, and got a complete medical history.  I cracked a joke or two, making him laugh and helping him feel at ease.  He said his wife would be coming in and bringing in his list of medications.

Ten minutes later, he was looking a little bit short of breath.  I checked his vital signs, listened to his lungs, asked how he was feeling, called the physician, and was given an order for a breathing treatment.  Five minutes after that, my orientee (a brand new nurse right out of school) yelled out my name from the room, and I ran in to find my patient moaning, with agonal respirations, and watched as his rhythm again converted to V-tach. I yelled for the doc, and searched for a femoral pulse as his moaning ceased and he went limp on the bed. 

The next two hours of my life were spent at his side, pumping every kind of medicine we could think of into his circulatory system, performing CPR, intubating him, performing additional testing whenever we got a pulse back for a few minutes.  Two ED docs, a cardiologist, a respiratory therapist, a medic, and three nurses worked in beautiful, cohesive unison to try to save the man's life.  Ultimately, despite our very best attempts, despite truly excellent team work and timely intervention, cardiac ultrasound confirmed that his heart muscle simply would not contract, and he was gone.  A man who I'd made laugh, only hours before, died under my hands.  And I found myself crying as I stood next to his wife as she sobbed and kissed his face, blaming herself for not being there to hold him when he died. 

I came home to find that of five ducklings, only three remained.

While walking back to the house from the yard, I accidentally crushed a firefly under my foot. 

By the time I got to bed, I could not stand the thought of another death.

Sometimes, in my line of work, people die.  Most of the time, they die because by the time they come through our doors, they're already gone.  It is very rare that someone comes in speaking to us, and leaves in a body bag.  I know for a fact that we did everything right, but it still feels like failure.