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Volume 2, Issue 2
Summer 2006:

A Death in Venice

Blair P. Grubb, MD

Cell 2 Soul. 2006 Summer; 2(2):a16

"When you arise in the morning,
think of what a privilege it is
to be alive: to breath, to think,
to enjoy, to love."

                    -Marcus Aurelius
                    Roman Emperor and Philosopher
                    121-180 C.E.

Venice is one of my favorite places in the world. A surreal city, it arises majestically from the waters like a misty dream. One feels a sense of enchantment flowing through the very canals that crisscross it like the lacework of a magic tapestry. My wife and I had come to this serene city ("la serenissima") to attend an international symposium that was being held there.

One afternoon (while my wife was away on a tour) following a lecture, I invited Carlos (a fellow conference participant) to join me for lunch at one of the picturesque cafes that line the city's narrow streets. We had no sooner received our orders when the head waiter ran over to us "Doctori!" he shouted (we still were wearing our name badges from the conference identifying us as physicians) "come quickly!"

We ran over to find a man sprawled in the street, looking ashen and motionless. He had no pulse, and was not breathing and could not be aroused. Quickly I tilted his head back, cleared his mouth of debris, and gave two quick breaths to fill his lungs. For a moment I wondered what varied and awful number of diseases I might be exposing myself to, but quickly forced the thought out of my mind. There was still no pulse or breathing. Carlos began to do chest compressions in sequence with my mouth-to-mouth respirations. We paused, again found he had no pulse or spontaneous respirations, and then resumed resuscitation.

Time seemed to pass in slow motion. The world consisted solely of mouth-to-mouth breathing and chest compressions. A crowd gathered. While other physicians from the conference offered to relieve Carlos from pumping, no one offered to relieve me. After what seemed an eternity (but in reality was probably only 10-15 minutes) an ambulance boat pulled up in the adjacent canal (in Venice the ambulances, like everything else, are on boats). The paramedics arrived and quickly and expertly took over for us, except that they used an Ambu bag in place of my mouth to continue to deliver respirations.

It was only then that I got a chance to look at the person we had been struggling to save. A late middle-aged man, he was dressed like the many tourists that thronged the streets. As the rescue squad rushed him into the waiting boat I walked back to our table in a daze, trying to wipe the man's saliva and food particles from my face. When I asked the head waiter (who had watched the whole event) where the bathroom was, he pointed in one direction and poured me a large glass of clear liquid. "Here," he said "rinse your mouth with this." I entered the bathroom and washed out my mouth with the liquid that burned like liquid fire (I later learned it was a kind of grappa). When I emerged he handed me a large snifter of what appeared to be cognac. For some reason I felt like I was trembling deep inside and downed the drink in a few quick gulps, feeling the warm heat of it travel to the very center of my being (comforted by the notion that no bacteria or virus I may have acquired could possibly survive such a chemical onslaught).

The waiter poured me another glass and led me back to our table. Carlos was there, as was our meal, but neither of us said or ate much. My thoughts drifted to the man, and what had become of him. Was he here with family? Did they know what had happened, or were they patiently waiting somewhere, wondering why he was so late? My hand trembled slightly as I took another sip of cognac. Why was I, who had participated in hundreds of codes, so shaken by this one? Perhaps because those others had all been in the sterile and controlled setting of the hospital, and this had been in the gritty reality of the street. Perhaps, because I had laid my mouth upon his and tried frantically to breath life back into his dying body.

The alcohol began to make my head swim. The man would not leave my thoughts. Why should I be concerned over him? After all there are 164,000 of us who leave this planet each day, balanced by the 190,000 who come fresh each day to replace them. What did it matter who this man was, why he was here, what his thoughts, hopes, and aspirations were? I'm sure that it mattered very much to the wife and children I imagined were waiting somewhere for his return, and beginning to worry about his absence.

A sudden movement next to me broke my train of thought. A young couple with a small baby was being seated at the table adjacent to us. Space is at a premium in Venice and the cafe's tables were squeezed together tightly. The child (a boy, I assumed, from his blue clothing) seated in a baby carrier was placed on a chair next to mine. To fit on the chair his carrier was positioned such that he faced directly toward me.

I glanced at the baby for a moment, then took another sip of brandy. When I looked back I suddenly became aware that the child was staring at me. Our eyes locked together, each quietly contemplating the other. Somehow, at that moment the mental burden of the man (and what I feared was his almost certain demise) suddenly lifted from me as I stared into this innocent child's eyes. Here was a life just beginning, even as another was just ending, with myself in a space somewhere in between. A vision of time, the absolute wonder and fragility of life and the passing of generations passed through my mind in an instant.

A broad grin broke out across my face and the baby smiled back with a look of impish delight. He held up his hand and I held out my hand in return. His tiny fingers wrapped around my index finger tightly, as our gazes stayed fixed on one another. Then, after a brief moment, I began to laugh and the child giggled, the warm Venice sun shone down upon us, and at once the world became whole again.

Reprinted from Pacing and Clinical Electrophysiology, 2006 March;
29(3):316-7, with permission from the author.

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