For the past three summers, I have worked as a patient escort in the radiology department of Presbyterian Hospital in Albuquerque, New Mexico. I transport patients between radiology and their rooms. Usually it is easy, but, as with anything in a hospital, there is always the chance of complications. People do not usually associate X-rays with life-or-death situations - I know I did not - but I learned. "One escort STAT, one escort STAT." At the sound of the intercom, I left my seat in the lounge and walked up to the front as fast as I could. There, Cody, a technician, grabbed me, and we wheeled a gurney towards the elevator. On the way up, Cody explained that the patient had been in stable condition when she came down to the department, but, sometime during the exam, her condition had begun to decline. As the elevator chimed to tell us we had reached the fifth floor, the patient's heart stopped. We got her off the elevator and rushed down the hall. Cody called a code blue, or a "code." Instantly, doctors and nurses came running, and I moved out of the way. There was nothing more I could do.

That was my first real encounter with a life-or-death situation. Needless to say, I was stunned. The gravity of the situation hit me even harder later that day when Cody told me that the woman had died.

The next day I walked over to the ER looking for X-ray films. As usual, I stopped to talk to the doctors and see how their days were going. One of the doctors came up to me and said, "I heard you had quite an experience yesterday." It was Dr. Jan Wiste, a long-time friend of my father's. I told her what had happened, and we had a conversation I have remembered ever since. She had worked in the ER for 15 years, long enough for her to have seen many critical cases and experience many deaths.

ER doctors have the same sort of limited relationship with their patients that I did. Many doctors get a chance to know their patients well through a professional relationship lasting years, whereas ER doctors only see their patients once, and only in emergency situations. Such a limited relationship provides insulation for them. If the woman I had transported had been one of the patients I saw every morning, her death would have had a more powerful effect on me. Dr. Wiste told me that it was common to feel the deaths of patients who were alert and talking more than those of patients who were comatose. "The act of communicating helps me to connect with the patient. In my mind, it changes them from 'patient' to 'human being,'" she said.

I told her that I felt bad about not being as upset as I thought I should have been, and Dr. Wiste shared that she cannot always relate to her patients, and that it is natural that some deaths have less of an impact than others. She said it is easier for her to establish an emotional connection with those patients who are about her own age. If she can see something of herself in the patient, it is harder to watch him or her die.

I commented that I wanted to become a pediatric oncologist, and that my friends often told me I was insane for wanting to work with children with cancer. She said, "You are insane." During her pediatric training, she said, she had worked with a four-year-old girl who had cystic fibrosis. Dr. Wiste was present when one of the little girl's friends "coded" and died. She said that the little girl just sat and watched, "almost as if she were learning how to die." The little girl died two days later. For Dr. Wiste, as for many people, the deaths of children are some of the hardest to cope with.

After someone dies, everyone wants to know why and whether it could have been avoided. When I heard that my patient had died, I wondered if I could have done anything else. There is always the thought, "Could I have walked faster? What if the elevator had not been so slow?" All the doctors I have ever talked to have dealt with this feeling. Dr. Wiste commented that she always wonders whether an alternate set of actions could have saved the patient. Usually, though, the answer to this question is no. "Don't feel bad," she said. "There's nothing you could have done to save her."

"Dr. Wiste, curtain 3, STAT. Dr. Wiste, curtain 3, STAT," came over the intercom. A whirlwind of labcoats and scrubs moved toward the patient areas. I picked up the X-ray films and left, hoping that they would be able to save this one.

Kristina Chongsiriwatana is a member of the Amherst College Class of 2000.