Some may question the advisability of airing this confessional remembrance to a broad audience, but Steve says that, for him, it is a story of efficiency gone horribly wrong, an inadequate reaction, and a singular event that can haunt one for a lifetime.  

SURPRISE ENDING

by Steve Goldfinger

He was in his mid-forties, comatose, febrile, and near the end. His hemophilia had caused uncontrollable bleeding throughout his body, and bacteria had infected his blood-laden tissues. A young attending, I led my team of house staff and students on rounds in our critical care area, stopping at his bedside only briefly. We had come to recognize that a huge number of transfusions had not made a difference; we could not stop the bleeding; and no new antibiotic was going to reverse the course. His vital signs told us he had entered the final stage. There was no family to contact, no friends we knew of. I commented that death was near and that no new measures made any sense. As we moved on to the next patient, our senior resident left us and went back towards the nurse’s station. We didn’t know why; nor did we ask. There were too many patients to be seen.

About 15 minutes later, he returned. “Well, it’s over,” he announced. When I asked what he meant, he told us. He had loaded a syringe with a lethal dose of potassium chloride and injected it into the dying patient’s vein. Instantaneous death occurred when it reached the heart and stopped it from beating.

Silence.

I was staggered by what he had done, so staggered that I was unable to say a word. We looked at each other. The group looked at me. I could not talk, could not imagine how he could have done such a thing, could not find a way to convert busy patient rounds into an ethics seminar. Could not even reprimand him as much as I felt I needed to.

Why? I continue to ask myself 40 years later.  Was I so intent on getting to all the patients that I failed to take a mandatory time out?  Was I unwilling to chastise him in front of all the others?  Would doing so require an explication of the moral principles he had violated? And was I capable of summoning up those principles and expressing them in an articulate way without time to recall them, reflect on them? Or, perhaps, did a small part of me completely understand what he had done and found it within reasonable, if not ethical, boundaries?

We received his report, and, a moment later, moved on to the next bedside without comment. Nor did I bring up this abhorrent act for discussion the following morning.

To this day, I am ashamed. I wonder how those students and interns regarded my silence.  Did they think this was a routine rite of passing endorsed by me, my colleagues, our profession? I can only hope that, as they moved on in their training, they came to recognize the event as the horrendous anomaly it was.

But in thinking about it now, was that injection of potassium chloride very different from the morphine drip that would some day come to use…ostensibly to reduce suffering…but, so often, in amounts that terminate breathing prematurely?

Who knows?

After a long career in medicine, Steve has been exploring his artistic side.  At BOLLI, he has taken writing courses, been active in the Writers Guild, and even tried CAST (Creativity in Acting, Storytelling, and Theatre) where his imagination made him a singular player!