I've seen this a lot professionally. I work on an ambulance, so this comes part and parcel with the job. A lot of people think that this is all we do, but in reality, 94% of the calls are mundane things, like people with the flu who can't get themselves to the hospital for various reasons. Maybe about 1% of the time we're using everything in our mental, physical, and pharmacological toolboxes, and getting to the hospital as fast as we can is the only thing left that we can do. On one hand, it might sound morbid to say I live for these calls, but on the other hand, people will end up this sick with or without my opinions on things, and I really do live to help people.

I'm going to set aside the question of heroin/opioid overdoses, because that's an incredibly nuanced question that deserves its own thread. I'm also going to leave out the question of criminal acts/assaults, for a similar reason.

Most people think of the dying as the people who need all the attention, and it's mostly true. But a lot of this thinking comes at the cost of the people on the sides. I'll never forget the first time I did CPR: it was on an infant, and the kiddo didn't make it. I felt really bad for the parents, because they obviously lost their child. There may be a dead/dying person in the room, but that room usually holds more patients than that.

Every once in a while, I'm in the hospital doing paperwork, and I'll hear a patient through the curtain. You try to ignore it, and most of the time, it's just background noise that's no more interesting than the "beep-beep-beep" of various machines. But sometimes you hear an elderly person ask to talk to someone about end-of-life decision making. It's an important decision, and on one hand, it sounds a lot like giving up on life. But on the other hand, they want some shred of agency in what happens if they stop breathing. All the doctors I know take this seriously, and in my experience, "Do Not Resuscitate" means just that. I will forever advocate for my patients' best interest, and that includes their end of life decisions. But even though I myself don't want to end up hopelessly stuck on a machine, hearing someone say those words drives a chill up my spine.

In the past, when we saw a warm, dead body, that meant CPR until we got the patient to the hospital, where a doctor would be the one to decide if efforts are futile. More recently, the decision has been given to the pre-hospital folks; if we've been doing CPR for half an hour or more, and the patient just isn't showing signs of recovering (we have a list of things to look for) then we can call a doctor, discuss the situation, and terminate efforts in the field. Usually there's nothing they can do in the ER that we can't do in the field these days, so it's a logical move -- racing through the streets with lights and sirens is an amazingly efficient way to cause traffic accidents, and we don't need to create business for ourselves. For some people, allowing a loved one to die at home is comforting; usually the family knew this was coming and there's a sense of "grammy's not in pain anymore." But in the case where the death was unexpected, it rips me apart every time we have to tell the family that we did our best, but there's nothing more we can do.

Sometimes the gods smile. We work really hard, throw everything we have at the patient, and the heart starts beating again. Usually this just means the family has a little more time to get to the bedside for last goodbyes. It's unusual that CPR results in a discharge from the hospital (and even more unusual that the discharge is without some neurological deficits.) But I believe that if we can give the family that moment, then maybe it'll help them cope better when the inevitable comes. When I hear the patient did make it, I get a lot of satisfaction.