Heartbeats

The following is “Heartbeats,” winner of the 2024 Narrative Writing Contest held by the UMass Chan Medical School chapter of the Gold Humanism Honor Society (GHHS). This contest was held during Solidarity Week for Compassionate Patient Care, a national celebration of compassionate and patient-centered care.

During my second year of medical school, we learned about something called depression with psychotic features. Basically, your brain copes with depression by creating mood-congruent psychoses—delusions that describe how you are feeling inside. During my third year of medical school, I saw a poignant example of depression with psychotic features that will always stick with me. Matt, a 29-year-old patient, sat across from us in the Berkshire Medical Psychiatric ward hunched over in a chair that was bolted to the ground.

“Please,” he begged. “Someone needs to check my heart again. It’s broken. I can feel that it stopped. I know you listened to it when I came in, and I got all the tests, but I promise you. It’s broken, I can feel that it stopped beating. Someone needs to help me; I swear that my heart is broken.” Matt had witnessed his fiancée die by suicide weeks prior, and in some sense, his delusions were not delusional. His heart, in the metaphorical sense, was truly broken.

During my fourth year, I rotated as a sub-intern at a busy urban trauma center. On busy 24-hour shifts, death would visit the trauma bay often and mercilessly. One night, multiple men with gunshot wounds arrived pulseless at once. One of the young men had suffered a gunshot wound through the chest. His heart had stopped but he was a candidate for an emergency thoracotomy. With incredible calmness, our trauma attending instructed the room through the steps. The residents cracked the young man’s chest open and carefully but quickly exposed his heart. We were instructed to press the heart in our palms to will it to beat again, being careful not to puncture the ventricles with our thumbs. We lined up to take turns performing open cardiac massage. With his heart in my hands, I could feel errant, erratic beats as the broken organ tried feebly to restart. It never did.

The attending physician called time of death. The resident asked me to help stitch up the patient’s chest before his family came in. “It’s the least we can do for him,” she said gently. As I started sewing up the young man’s chest, I tried to softly close his eyelids out of respect. They stayed open, staring directly at me. I wondered what the last thing he saw was. I pulled his skin together, trying to work gingerly even though I knew he could no longer feel it. Our attending came to speak with the team. He had just spoken with the patient’s mother in the emergency department waiting room. This was the second son she had lost to gun violence. Shortly after, we heard her screams cut through the room. Grief and heartbreak saturated the air with a heaviness that made it feel impossible to breathe. I could feel my own heart beating fast and heavy. Later I arrived home and collapsed for a few hours. I awoke to my parents Facetiming me from one of my childhood best friend’s wedding, which I had been planning to attend until committing to the trauma rotation. The sun is setting over the rolling hills of a sprawling vineyard in Newport. Familiar faces of friends and family from across the country are beaming through the screen, warm with the buzz of wine. Tears sting my eyes as I congratulate the bride, stunning as ever and filled with the heartfelt love surrounding her.

They ask me how I am doing. I don’t know what to say. I am witnessing the biggest joy of someone’s life through my phone, while thinking about how fragile and unfair life can be. My feet are tired, the skin is peeling off from sweating in my surgical clogs and standing while wearing protective lead for hours on end. My eyes feel strained, they have seen too much and been open for too long. My ears are ringing from the beeping, the screaming, and the endless sounds of the hospital. The silence in my lonely apartment now feels jarring. My chest feels heavy; my own heart feels broken.

Tonight, I will crawl into bed. I may be haunted by dreams of the nights prior, but my body will rest, and I will sleep. Unlike so many I have seen whose hearts have stopped or been maimed, I get to wake up tomorrow. I will go to the hospital, still tired but regenerating. My feet will be a bit less sore, eyes a bit brighter, heart slowly healing, weight on my shoulders just a little bit lighter. I have seen the practitioners around me continue to conduct their clinical duties with humanism and empathy, even after heartbreak and repeated tragedy and I am determined to follow in their footsteps.

(All names changed for privacy)

Rachel Schneider, MPH, MD Candidate, Class of 2024, UMass Chan Medical SchoolEmail: rachel.schneider@umassmed.edu