The world seemed to me to be divided primarily into two groups of people. Those who credit a puppet-master in the sky for pulling all the strings, and those who believe we’re on our own. Then there are confused folks like me who are on both sides of the aisle theologically. I wasn’t naïve enough to think Tarini’s heart would start on its own by divine intervention, but if God wanted to assist in the matter, I was all for the help.
         None of it felt real. We had participated in plenty of CODE BLUE cardiac arrests, but always in the hospital where the environment was controllable, and personnel back-up, drugs, and defibrillators were plentiful. Usually there was a degree of separation between the doctors and the patients that allowed for clear and logical thinking. Our personal feelings about Tarini bred an intensely intimate and visceral response. Panic never helps a resuscitation effort, and we were all panicked. People watch heroic CPR on television where the victim wakes up with Pamela Anderson or another Baywatch beauty pressed against his lips, and assume it always works that way in real life. But, this wasn’t television. There were no dramatized characters saying, “Come on man, you’ve got to make it. Don’t you die on me now!”
            We were all trying to stay focused on getting the job done for Tarini. Consistent with the statistics, we were not reviving her despite our best efforts. In the background, Karen was screaming at the 911 operator to get help to us faster. We momentarily gained composure and then got back into sequence. Perspiration born from raw exasperation dripped out of every skin pore. Every few minutes or so, I felt another one of Tarini’s ribs fracture during my chest compressions, as is the usual case in prolonged CPR. Whether or not Tarini felt anything was impossible to discern. She wasn’t displaying any signs of suffering. A grimace or a moan would have been gratifying in a situation so desperate.
            Patients who have pulled out of a close brush with death have told me that the dying process paradoxically made them feel more alive than ever before. Not only on a psychological level of being able to understand completely what’s important and what they will miss, but on a physical level as well. They cherish each palpitation of blood in their vessels. Each breath becomes so monumental that they can’t imagine how most days proceeded without them ever thinking about breathing.
             We only die once, and each experience is intimate and unique. Death is something we don’t usually schedule into our lives, but the disease of mortality is an affliction we all encounter, eventually. As a frequent observer of the process, it’s something I’ve thought a lot about, but that experience complicated everything.
            When performing CPR, it’s essential to allow for a brief pause in chest compressions to feel for a pulse every couple of minutes. If the heart starts beating you don’t want to continue traumatizing the chest. My fingers pressed into Tarini’s neck in an attempt to detect blood flow in her carotid artery. For a second I thought there was a pulse, but then realized my panic had caused an amateurish error. My own pulse was pounding so hard in my fingertips that I had attributed it to Tarini’s heart. When I palpated my own carotid artery with my other hand, the pulses in both hands were unambiguously synchronous with each other.
            The paramedics finally arrived. They hooked up the heart monitor, and we scrutinized the dreadful flat rhythm of asystole. Tarini’s heart did not contain even a slight trace of electricity to shock it back to life. I mustered up the courage to look at Grant. He stood silently, staring at the monitor. I fixated on his small chin scar that he once claimed was from a tumble in kindergarten due to an untied shoelace. Then he turned his head downward, buried his chin in his chest, and began to sob convulsively.

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The events that followed are almost picture perfect in my memory. Grant freaked out because he couldn’t feel a pulse. I started chest compressions. He gave rescue breaths. Karen called the 911 dispatcher.

Tarini didn’t feel cold, but she didn’t feel warm either. Her petite body was naked under a long white shirt. Her lips were blue, and her hands and feet appeared mottled. The pupils of her once beautiful emerald green eyes were dilated and fixed. If the eyes are the windows to the soul, as some say, then her soul seemed to have departed. When the brain isn’t getting oxygen, it starts dying after four minutes. We had wasted precious time being idiots outside the pantry door. Was she not breathing that entire time? As a critical-care physician, I knew the grim statistics for surviving an out-of-hospital cardiac arrest, but the thought of not generating a successful resuscitation didn’t cross my mind, nor apparently the minds of any of my friends.

The Other Face of Murder
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Gil Porat, M.D, FACP, CPT

Chapter Three