To Sleep, Perchance To Dream

I will finish my reminiscence off of my time in NSW soon but here is a page from a day when things got a little bit hectic at work. Please forgive the medical jargon, and just fast forward pass the bits that don't make sense. It is the humanness of the story that I am interested in the end, as always.

11 July 2009

I love cardiac arrests. Nothing stirs you from the slumber of a lousy ward day than a bona fide full on cardiac arrest.

Today I didn’t manage to save a lady from dying. She was in the hospital for chest pains which we had investigated at length but all our leads ended in cul-de-sacs. She had developed some abdominal pain and low blood pressure overnight, and the consultant this morning wanted to do a scan on her to make sure that she didn’t actually have a weakening of her main blood vessel, the aorta.

And so the arrangements were made for her to be brought to the nearby big hospital in PM for her CT scan. She was never to make that journey as I was asked to see her later that morning as she was becoming more breathless and dropping her blood pressure.

I must admit that my mind was still ambling at the pace of a ward round, and I suggested silly reflex things like ventolin or Lasix when obviously this lady was dying right before my very eyes.

And soon the fog cleared up and I asked them to bring the BIPAP machine (a tight mask that fits over her face to help with her breathing) to her bedside, by which time she started becoming unresponsive. The cardiac monitors still showed a heart trace, but we couldn’t get a blood pressure and her oxygen saturations were dropping faster than a stock market in the Great Depression.

We got her dentures out and put in a Guedel’s airway which sat rather awkwardly in her mouth. I tried to bag and mask her unsuccessfully as I had difficulty getting a good seal. One of the nurse slammed the emergency buzzer on my harried command, and soon help arrived. We proceeded to put a nasopharyhgeal airway instead, and tried to ventilate her better with the bag and mask.

But we were all fairly junior and standing there like lost deers, before the consultant came by, and joined us in standing around like lost deers. This lady was dying before us and we didn’t know how to fix her.

We couldn’t get a blood pressure and the cells in her body were slowly dying from the lack of oxygen. We were throwing aramine and gelofusin at her, but the blood pressure still could not be detected. The decision was finally made to put a tube in her throat to make ventilation easier.

I picked the short straw and had the unenviable task of putting the tube into her gummy mouth.

I asked for suction to clear out the saliva pooling at the back of her throat, and then moved in the steel laryngoscopic blade and pulled her tongue aside. It was touch-and-go for a moment when I tried to manipulate the back of her throat to visualise the vocal cords better, but finally there it was in all its slitty glory, opening up for the plastic tube invitingly.

I didn’t need a second invitation. I whispered a quick prayer and put in the tube, a little too far in, admittedly, but there was great satisfaction in seeing her chest rise and fall as the bag was put onto the tube and pressed to inflate her lungs. The anaesthetist finally appeared, pleased to see that the tube was in, albeit a little too far in, and got it readjusted.

All this action became a little too much for her to take in the end, and her heart finally gave way. We started resuscitation, threw in the adrenaline, atropine and lignocaine combination but to little avail.

Her son was sitting at her feet all this time. They said he would be really lost without her, because he had a mental illness and was staying with her in a dependent manner.

Somehow, by the grace of God, there was no frantic hysteria as Mum entered her last leg of her race in life.

There was almost a peace that passeth understanding permeating him, as he held Mum’s hand and told her that he was there.

Sitting there at the end of the bed, he watched the doctors and nurses panic with their dilated pupils, their nostrils flared, their arms shaking, conjuring up all their magical spells and charms to try and ward off Death one more time.

The son, complete with straggly hair and unkempt beard, stood calmly before us when it was all over and we broke the bad news. It was almost like watching Mum pass away and watching the staff do everything they possibly could was therapeutic or a release of sorts for him.

There was an almost eerie clarity and purpose as he said, “ Nope, I’ve got to go to the solicitors and sort out Mum’s last will and wishes, and get some things from her cupboard, but thank you for all that you have done for Mum. I don’t have time to cry yet, but I will soon, but now is the time to get things done.”

Some people fall apart in the face of the death of a loved one. Others gain a lucidity and an energy to move purposefully to do the necessary things, and honour the wishes of their dearly departed, knowing that in this whirlwind chaos of activity that follows death, they will somehow find that little pocket to grieve for their loved ones, but not just yet.