I am a firm believer in the idea that everyone participates in our lives for specific reasons. Some people are like tattoos, permanent markings accompanying us through life. Others are less permanent, like the latest hairstyle, bringing experiences or lessons that help us grow along the way.  The constant inflow and outflow of relationships in our lives is like the Emergency Room of a hospital: some relationships are beyond saving, and others can be cured if we provide them the spot they need in an overcrowded hospital wing.

Three weeks of not talking post-graduation and here I was, accepting a dinner date with my boyfriend of almost a year and a half. Makeup melting and skin searing as soon as I stepped out the door and into the Arizona summer, I hopped in the car and immediately suffered a blast of air conditioning to the face followed by a nonchalant "Hey, what's up?" from the boy we will call Nick. I waited for him to start conversation, yet instead was welcomed by unfamiliar silence accompanied by the brush of his palms against the steering wheel and the rhythmic clicking of the turn signals. The balloon of air subconsciously trapped in my lungs deflated as we reached the parking lot. Nick fumbled with his seatbelt and exited the car, his face expressionless, and then followed me into the restaurant. We sat at our usual table and updated each other on the beginnings of our summers. I felt as though I were on a first date, trying to keep conversation afloat and hide the shaky corners of my faux smile. In this moment I finally realized that our relationship had reached code blue. Cardiac arrest. Danger zone.

After dinner we drove to an empty parking lot, got out of the car, and sat on the curbside. The warm summer breeze tickled my skin, sending a fleet of goosebumps down my legs. Scraping my dirty Converse Hi-Tops in the gravel, I felt the air between Nick and me turn to syrup—an indescribable thickness dampening my palms and forehead. I gulped for the oxygen that seemed to pull itself away from my lungs. Unable to part my lips, I sat perched on the curb, an unmoving sculpture, waiting for Nick to begin talking.

“So,” he said. “I’ve been thinking lately.”

I immediately began running through the list of our past discussions: Oh no. What in the world could I have done wrong this time? I already gave up so much to make sure I was spending time with him: I hung out with his friends more than my own, what more could he want now?

“Nicole, I love you to death and I always will.” Voice quivering and unable to look me in the eyes, he began his list of my faults which expanded over the course of the next hour:

“You don’t go to parties... You don’t skip work to hang out with me... You are too busy with sports... You care about school too much... You aren’t living in the dorms for college... Oh, you make me pick you up to go to dinner or on dates... You make me spend time with your family... You don’t have enough friends... You are antisocial...”

In a nutshell, I was not good enough.

Turning my head to watch the pinks and oranges of the sunset turn to night, I tried to grasp what was wrong with me. I was defeated, not out of sadness but out of anger. I had tried CPR, given 100 mL of Lidocaine, and even a shot of Epinephrine. The nurses surrounding me pulled at my shoulders, urging me to let go: the patient had flatlined and there was nothing we could do. I continued to administer CPR, thinking if I tried hard enough there would be some way to bring him back. Meanwhile, there were several patients checked in and waiting to be let in. People that could be saved, that have more value in my life.

Yes, I could have seen the symptoms earlier and tried to remedy the situation. Yes, I was a busy girl and had a lot going on. Maybe I was not present enough in the relationship. Maybe I am not good enough for anyone.

I was as in shock as a new MD losing her first patient. “Take me home,” I demanded, and Nick began the drive back to my house. As I unbuckled and stepped out of the car, I heard, “Maybe we can try this again when you become more independent.” I did not so much as look back as the car door closed behind me. I realized how much I had defined myself by how others saw me. I threw myself into saving every patient, even the obvious fatalities, closing my mind off to the relationships that had a fighting chance. The patients who appreciated my efforts; those who brought as much sustenance into my life as I did to theirs. Those who saw my worth.

I walked in the door and directly went to my mother’s room, finding her in mid-face wash with the familiar smell of coconut wafting through her bedroom. I perched on the bathtub and blurted, “We broke up,” and cried for barely thirty seconds before declaring, “Okay. I’m over it.”

“Well that was easy enough,” said my mother with a smirk on her face. She is one of the ER regulars, stopping in with her two boys and their countless bumps and bruises and their semi-permanent second home in room three. She is a constant voice of sanity that makes me realize my full potential as a doctor, no matter what the situation. I can count on her to show up for her weekly dose of Dr. Falls, with a good piece of advice tucked behind her ear. I quickly realized I should have listened to her as she hollered down the hallway or followed me into the bathroom as I wiped my tears the first time our relationship hiccupped, and our lives slowly slipped out of sync.

Even though the relationship ended harshly, I had no regrets regarding the time invested. So many beautiful memories were created that I will cherish forever, similar to memories like Match Day and graduation for medical doctors. These events represent positive aspects of ephemeral relationships; so many sad aspects encompass the end of a relationship, but countless opportunities are present to learn, grow, and move forward from the hard endings.

As devastating as a patient loss can be, I finally came to terms with who I am and realized how much more I had to exchange with others. There is only so much time to develop lasting relationships, and I learned that not everyone is destined to take those spots in my life. Whether it be a weekly or daily dose of Sertraline or a follow-up for a chest drain, each patient builds the resume and experience that I have today. I became aware of the power of both positive and negative relationships, and the consequences for holding on too tightly to something that is itching to exit. And the next time I have a code blue, I know I am prepared for any outcome.