Tuesday, October 6, 2009

Do Not Go Gentle Into the Good Night

So I walked into the ED one Sunday night and it was chaos. It looked like a bomb had struck the place after a hurricane and a tsunami had hit it. The crap did not only hit the industrial strength fan, it also hit the full-blast air-conditioning and the heating in the ventilation.

But enough bad analogies.

Just before I had walked in, there were three simultaneous codes - a 91 year old man who had a large aneurysm of his aorta (swelling of the main blood vessel in the tummy area), another seventy something year old gentleman was having seizures from the newly diagnosed brain tumour in his head, and there was a 30-something year old mother who had overdosed on a whole heap of medications who no one could wake.

And she was vomiting out blood as well for good measure.

And so the whole department was abuzz with doctors and nurses flying from one end to the other, trying to put out as many fires as they could.

Every bed was taken in the Emergency Department that night, as evidenced by the full waiting room outside, as we had neither the time nor the place to see anyone.

My boss went out and told the waiting patients in no uncertain terms that tonight the ED was really busy, and unless they were willing to wait for a long time or thought that their ailment needed attention this very night, they would be better off coming back tomorrow. Or never.

Please, thank you, come again.

The surgeons were in the room seeing the gentleman with the 10 centimetre aorta that was about to rupture, trying to convince him that he needed an operation urgently. His wife and daughter were there by his side keeping vigil.

His wife stood there by his side telling him that he should probably have the operation. For the longest time the man kept silent while she talked on and on about how he should have it. She was trying to cope with the sudden bad news and her mind was grasping at straws at this stage. She was about to lose him and she wasn't ready yet. So, yes, yes to the operation. Yes to hope.

20 metres away in another room, a young mother was trying her best to die on us. Her family had checked in on her at six pm that day and thought that she was sleeping so they had left her alone. It was only when she didn't rouse that night when they called her to dinner that they feared the worst.

They rushed into her room, the pack of empty pills by her side and she would not respond to their frantic calls trying to coax her back from Death's edge. Her brother had tried to sit her up, and she had vomited out blood in his arms, and the family were beside themselves as the call for help went out.

Many women have tried to take their own lives, but more often than not, it is actually a cry for help and most survive. I have never seen someone come so near to death on overdosing on pills before.

And so we were trying to put the tube down her throat to help her breathe, and all this time the blood gushing out of her stomach made it very difficult. Then we had to get lines into her to give her the medications that would keep her blood pressure up.

We had to keep reaching for some shots of adrenaline to bring the blood pressure to a level where it would perfuse the vital organs in the body.

The man with the brain tumour had finally settled from his convulsions with the medications that he was given. His family sat next to him, distraught at what they had just witnessed. Just this morning he was fine - he was their father, their husband - having breakfast with them, laughing about things and now eight hours later his body no longer belonged to him.

It was weak on one side and would not respond no matter how hard he willed it, and when he fitted, he jerked around as if he were being drawn on the strings by an invisible puppeteer.

We had to attend to the man with the enlarged aorta because he had suddenly lost consciousness. As we stepped in, the surgical registrar dramatically waved us away, his arms cutting open in a fashion like No Deal!

he exclaimed. Don't do anything!

The surgical registrar recounted to us what had happened, his eyes wide open in surprise. It was the most amazing thing! he exclaimed. So we were just telling him about the operation when this man suddenly turned to his wife and daughter and said, angrily -

"I've had enough! I don't want anything done for me anymore! See you! Goodbye!"

And with that he just... went.

The surgical registrar's voice trailed off, amazed that the man could dictate his own death.

[Mr A leaves the play, never to return. Exit Stage Left]

My boss went out to talk to the family to confirm the man's last wishes, and he returned to the room, his single nod confirming that this man should be kept comfortable only.

Back in the room with the young mother, we battled on and had to throw a heap of medication at her in order to keep her blood pressure up, in order to stop her from the death she wanted so much. She was finally flown away to another hospital that night, her family still coming to terms with their grief and now needing to find their way to her tonight.

There is time to breathe, and reflect. Here was one man who had lived a good long life, and had seen many things in his time, and who was just sick of it all. He somehow wielded the power over the timing of his death -nature had finally taken its course, and he wanted no more of our withcraft to try and stop it.

On the other hand, here was a young mother, who at a very young age decided that she had seen enough in her time and was just sick of it all as well. And in some strange way, she wielded the power over the timing of her death as well, but the love of her family, and the same modern medicine that brought her to the brink of death was trying its best to pull her back to life.

No comments: