I get asked a lot of questions about my job. Simply stated, when asked “What do you do?”, my response, “I’m a trauma surgeon” is often a conversation starter and questions quickly ensue.

“Do you work in the ER?”

“What kind of surgeries do you do?”

“What’s the coolest thing you’ve ever seen?”

“Do you see a lot of gunshot wounds?”

And so on and so forth.

And in general, I try to be as open and informative as possible.

There is one question, however, that is often asked and rarely truly answered.

“What is the hardest part of your job?”

Admittedly, as much as I love my job, there are some seemingly glaring downsides. I never really know what I am going to do any given day. I work long hours…. like, really long hours. Like, think long hours then double it. I work days, nights, weekends, holidays, and birthdays without any regularity or consistency. My job is intense, stressful, and I am a first-hand witness to the destruction human beings inflict not only on each other, but also on themselves.

But none of these are the worst part of my job.

When someone dies from a traumatic injury… well, for lack of a better word, it’s traumatic. It is sudden. It is unexpected. It is unforeseen. They woke up that morning, put on their socks and shoes, and walked out of their home… never realizing they would never see home again.

When someone dies from a traumatic injury – they are brought into the hospital, and we try to save them. We place tubes, we place lines, we perform surgeries. But this flurry of activity isn’t just occurring inside my operating room. Outside of these sterile walls, police are attempting to identify the patient, then the next of kin, then get in contact with the next of kin, whom are typically told some version of what maybe caused the injury, and the family come flying into the hospital – scared, hopeful, sometimes in groups, sometimes alone and always unknowing. They have no idea what type or severity of injuries their loved ones has, because all of this occurs typically simultaneous with me diagnosing, treating, and operating on those injuries.

When my patient dies, after I am unable to save my patient, I call the time of death. Then, I call our social worker to see if family has been found, and if so, to find out where they are. They are then brought to a room… still anxious, still nervous, still unsure of what has happened or what is happening. They wait to talk to “the surgeon”. They wait with questions, thoughts, and words crowding their brains, reassuring themselves that whatever it is, it just can’t be that bad, their loved one is needed, wanted – they HAVE to be okay.

And while they wait, while their brains race, feet pace and hearts ache, yearning for information…I change my scrubs, wash my shoes, check my face in the mirror – all to make sure they don’t see the blood of their loved one on me.

I then enter that small room where they wait, and their eyes turn to me – full of questions, anxiety, often tears, and always hope. Hope that maybe it isn’t as bad as they have feared. Hope that they can see their loved one soon. Hope that I am going to tell them everything is going to be okay, their life will be the same… with their loved one in it.

My entrance into that room is the worst part of my job.

No, it isn’t the actual giving of the words, “I’m sorry your loved one has died”. It isn’t the watching of tears falling or the listening to the sounds of pure, unadulterated sorrow that follow. It is actually those moments before I tell them their loved one is dead which give me pain. Because those moments are pregnant with possibility. I can see all their hopes and dreams for their loved ones – the birthdays, the hugs, the trips, the children … the time. I see the time they are so sure they will still have. I see the time they never imagined not having. So many possibilities… of all the things I know never will be. There will be no more birthdays. No more hugs. No more words exchanged, memories created, or dreams shared. My words, in the next few moments, will shatter all of those possibilities. Those possibilities will be replaced by pain. That hope will now be denial. That sense of what life is will be lost… the life they know will be gone… replaced by confusion and bewilderment at the harsh new reality into which my words have forced them.

It is the moments before the tears and the anguish that is the worst part of my job. It is seeing the light in their eyes and having the knowledge that I will be extinguishing that light. This is what leaves its mark on me. Because that light represents my patient… who they were, how they loved and how they were loved, all they were… and all they never will be.

That is the hardest part of my job.