I am no stranger to the scene playing out before me. This time is different though. No longer am I the silent scribe in the corner, fingers deftly tapping keys as I prepare the chart. Instead, I stand near the foot of the bed, an observer of the physician role. I watch as people decorated like jewels in various shades of blues, reds, and greens, weave in and around each other as they prepare the room. Monitors are turned on and wires untangled. A series of beeps sound as a cart is unlocked and drawers opened to pull out handfuls of saline syringes, needles, and tourniquets. In the corner, an ultrasound machine boots up, the resident who will wield it preemptively placing gel on the probe. A nurse in dark blue with a calm face to match stands at a red cart that acts as her helm, clicking her pen to begin jotting down notes of what is currently known of the patient en route.
A young man went down while playing basketball. Possible seizure-like activity? Unsure if his friends performed any resuscitative measures. Narcan, epi, and two shocks were given by EMS.
They are still doing CPR.
My endless hours of studying and exams kick in, mind rifling through knowledge and facts to land on the file labeled: hypertrophic obstructive cardiomyopathy (HOCM). The scenario unfurling before me mimics the ones I have read about numerous times before. A young, healthy male who suddenly passes out and goes into cardiac arrest while playing a sport. Of course, some additional details and key hints found in the stem are not fed to me in real life. But this story sounds eerily similar.
The HOCM questions on the exams rarely extend past the diagnosis or underlying cause. And they never describe the flurry of activity as the ambulance bay doors swing open, and a stretcher is wheeled in by a small hoard of EMTs laden with monitors, papers, and rhythm strips. The words on my exams never paint the picture of how the patient will be laying on the stretcher, an Automated Chest Compression (ACC) device positioned over him to deliver violent compressions that wrack his body.
It never mentions that the patient may only be wearing one shoe.
The room delves into organized chaos as he is transferred off the stretcher to the bed. Stickers are placed all over his chest and limbs, wires hooked up to capture his pulse and rhythm. Techs stand on either side, working with needles to get IV access. Faintly, amongst the din, I hear the whirring of the blood pressure cuff as it inflates, the rhythmic puffs of an ambu bag being squeezed. Someone starts counting down from three, and there’s a brief pause as the ACC is stopped, swiftly removed, and replaced by someone to resume compressions. The attending standing next to me absorbs information being fed to her by strips and monitors and screens and then calls out instructions in response.
My eyes, looking away from the grainy salt-and-pepper ultrasound image of the heart towards the cardiac monitor displaying a flat line, momentarily pass over a singular black and lime-green basketball shoe adorning his right foot. And my mind snags on the fact that his left foot does not bear a shoe to match.
Where’s your other shoe? I think to myself, eyes darting around. Why did they take it off? Did it make it to the hospital here with you?
You shouldn’t have to die wearing only one shoe.
I had been determinedly clutching onto hope when I first walked into that room. Hope that we’d be successful in our efforts, that this patient wouldn’t be another poor survival statistic. But too much time had passed, with no detection of a shockable rhythm, and multiple rounds of epi given. Hope had evaporated into thin air.
I glanced at that shoe one more time, at the left foot only covered by a sock, before leaving the room. It seems that my brain took a snapshot of that scene, and it’s now embedded in my memory. Since that day, I’ve asked myself why such a small and inconsequential detail captured my attention so tightly. And I think it’s because it grounded me to the person we were coding. Not the unstable vitals. Not the problem of cardiac arrest. Not the lack of a shockable rhythm. But a person who loved playing basketball. Perhaps those had been his favorite pair of shoes. Maybe he’d selected them for himself, or they’d been a gift. I imagine those shoes carrying him through countless hours of practice and games, in wins and losses, in joy and defeat.
Maybe the missing shoe did matter after all.
Kathleen LeFiles is a medical student from the Class of 2026 at The University of Arizona College of Medicine - Phoenix. She graduated in 2020 from The University of Arizona in Tucson with a degree in Physiology and a minor in Care, Health, and Society. When she's not studying or writing, Kathleen enjoys practicing Pilates and yoga, frequenting local coffee shops, and listening to pop music. Feel free to contact her @kathleenlefiles on Instagram or email at klefiles@arizona.edu.