From First Alarm to Last Light

A First-Person Perspective Written By Philip D. Glickstein, CPTC, CTBS, CST

I hear the words Free Kill the way one hears a slur spoken casually by someone who has never earned the right to speak at all. It lands not as analysis, but as accusation—flat, careless, and heavy with judgment. It is spoken from a distance, from a place where outcomes are tidy and hindsight is cheap. It is uttered in legislative halls by people who have never stood in the breach at a bedside, in news stories trimmed to fit between advertisements, and on social media, where outrage travels faster than understanding. The speaker uses the phrase to provoke emotion, to shock, to simplify. For someone who has never stood ankle-deep in urgency—where medical skill and seconds collapse into the same thing—never felt the clock tighten around a failing body, the phrase may sound clever, even righteous. To me, it sounds obscene.

I have come out of Critical Care Units and Operating Rooms where my ears still rang with alarms long after the patient was gone. That sound follows you. It embeds itself somewhere behind the eyes. I have peeled off scrubs stiff with sweat and other people’s blood, stood under flickering fluorescent locker-room lights that show every crease of exhaustion, and felt my hands tremble—not from fear, but from the delayed recognition that what I had just done mattered, and that it might not have been enough. Sixteen hours of life compress into a blur: intubations done by feel more than sight, cracked ribs beneath your palms during compressions, shouted orders for medications whose names blur together when spoken fast enough, silent nods between people who no longer need words. We perform an unspoken calculus of near-miracles when time is the enemy and perfection is a luxury no one can afford. In those moments, protocols are not commandments etched in stone or statute books; they are tools—guidelines sometimes followed, sometimes bent, sometimes abandoned altogether in favor of something older and more primitive: judgment.

Medicine at the sharp end is not practiced in paragraphs or statutes. It is practiced in clipped commands, in gestures, in glances, in seconds. Decisions are made with partial information, obscured histories, malfunctioning machines, and bodies that refuse to behave the way textbooks promised they would. There is always something missing: a lab result that never came back, a scan that was delayed, a history no one had time to take. You act, because not acting is its own decision, and often the most lethal one. You suppress the human reaction to what lies in front of you—the limp body of a child, the mottled skin of someone whose circulation is failing—because emotion has no place at the bedside when airways are closing and hearts are stuttering. Emotion comes later. It always comes later.

And when the patient dies—and sometimes they do, despite everything—you carry that weight with you. You carry it home. It replays on a continuous loop in your brain while you shower off the day, where water becomes an accomplice to memory. You replay it in the car, stopped at red lights that feel obscene in their normalcy. You replay it in the quiet moments when the world finally slows enough to let doubt speak. Did I miss something? Should I have waited? Should I have moved faster? There is no statute of limitations on those questions.

Now imagine standing there, exhausted, stripped down to the bone by the day, changing clothes before going home, and hearing someone—someone who has never smelled cautery smoke, never watched a monitor flatline, never felt the slippery resistance of skin beneath their palms during chest compressions, never had to look a family in the eye and say the words there’s nothing more we can do—declare that what just happened was a Free Kill. Not a tragedy. Not the failure of a human body that was already unraveling. Not even a hard, arguable question of negligence. A kill. Free. As if the work were casual. As if the loss were transactional. As if the people who tried to stop death were somehow its beneficiaries.

What makes the phrase especially grotesque is not only its cruelty, but its falsity. Intentional killing by physicians is almost nonexistent—so rare over the span of decades that it stands out precisely because it is aberrant. Meanwhile, the overwhelming majority of intentional killings in this country occur far from hospitals, far from operating rooms, committed by people who know their victims intimately. Violence in America is personal, domestic, and familiar. To linguistically place doctors alongside killers is not merely inaccurate; it is a profound misrepresentation of reality.

And yet, unintentional medical deaths do occur. They occur not because medicine is indifferent, but because medicine is human, complex, and practiced at scale. Millions of decisions are made every day by tired people working in imperfect systems. Errors happen. Systems fail. Communication breaks down. But to describe those failures as Free Kill is to collapse a systems problem into a moral indictment. It trades understanding for outrage. It replaces inquiry with accusation.

Those who have never worked in critical care often imagine negligence as something obvious: a careless hand, a lazy decision, a moment of disregard. They do not see the other kind—the negligence that emerges from understaffing, from fatigue, from protocols written by committees far from the bedside, from electronic systems that steal time rather than save it. They do not see the quiet heroism of people who show up again and again, knowing that even perfect effort does not guarantee survival.

That is why the term offends. Not because it denies accountability—those of us who work in medicine know better than anyone that accountability matters—but because it replaces moral seriousness with moral laziness. It caricatures a profession defined by vigilance as predatory. It assigns intent where there was urgency, malice where there was exhaustion, and indifference where there was often anguish. It allows the speaker to feel righteous without being responsible.

Laypeople should avoid the term not out of politeness, but out of humility. Words like Free Kill pretend to explain something they do not understand, and in doing so, they wound the very people whose cooperation is essential if medicine is ever to become safer. Accountability does not begin with accusation. It begins with honesty—about systems, about limits, about the brutal arithmetic of life and death, where even flawless effort can end in loss.

Those of us who have worked there do not need euphemism. We need accuracy. We need language that can hold complexity without flinching. And we need a public discourse that recognizes this simple truth: when you have spent the day holding death at bay with bare hands, the last thing you deserve is to be told—by someone safely removed from the blood, the noise, and the cost—that you killed someone for free.