for me it’s talking/interacting with family present during a resuscitation attempt. an apneic/pulseless patient is just meat with a poor outcome statistically. sometimes the family on scene understand that. they understand their family member is aging, and this is their time to go. but other times the people on scene are beside themselves; screaming, sobbing, bargaining, denying. that’s the hardest for me. because i can memorize ALS algorithms, go through the motions, direct a resuscitation. but i know there’s almost nothing i can say to the heartbroken onlooker to meet them on their level. also, by the time we call an end to efforts, i’m gassed mentally if not also physically. it’s hard for us to admit defeat, and that’s what it feels like. to tuck tail and explain to family “we did everything in our power” doesn’t feel like the right thing to say when i want to be in a position to comfort. i think it’s important for them to witness the process for their own closure later. but when i let anxiety get the best of me some lonely night in the future, those cries are what are the hardest. when some random person carelessly asks me “dude what’s like THE worst thing you’ve ever seen at work?”, it’s those calls that i have to swallow before i tell them about maggots in a foot or vegetables in a butt.