Sunday, April 18, 2010

The Opposite of A Birthday

When You Least Suspect It

The doctor is sitting at his desk, in the area designated to quickly review the less urgent patients.

It has been a relatively quiet day, being a public holiday. He glances at the computer screen and marvels at how decent the patient numbers actually look. Nothing like a public holiday to put into perspective which pains and aches truly could wait.


An alarm shatters the relative silence of the department. He looks towards the alarm and rises from his seat.

Someone had triggered the Emergency Alarm button, calling for help. It was either a doctor, or a patient, and usually a host of doctors and nurses would rush with the resuscitation trolley to wherever the emergency was.

Often times it was a false alarm - a patient would have accidentally triggered it in the toilet or in their cubicles. Often, a nurse would step in and cancel the false alarm.

This one kept alarming.

The doctor keeps walking and looks up at the alarm monitor display. The number 1 flashed in red.

1 spelt trouble. 1 was the resuscitation cubicle.

How To (Desperately Try To) Save A Life

He rushes to the cubicle, and the first thing he sees is A, a fellow colleague who was pumping away on the chest of a patient. Another doctor, J, is feverishly trying to put in a needle in order to give the patient fluids and medications.

There were just the two doctors there as the other doctors were all in handover.

The doctor joins the other two doctors, and the two nurses - one is trying to get a second needle into the other arm, the other one is assisting the patient's breathing with a bag and mask.

The doctor walks up to the head of the bed. His pupils dilate and his pulse quickens. The patient looked young, and fit.

The defibrillation pads are on, and it showed that the patient's heart was beating in an erratic and ineffective manner. A is doing CPR like a man possessed, massaging the patient's heart artificially so that his vital organs remain perfused.

There are shouts in the flurry of chaos for adrenaline, and for fluids to be put up, The nurse are scuttling to and from the drug cupboards, getting the medications. Another nurse is standing in the corner, whose sole purpose is to document everything that is going on.

The doctor takes over from the nurse and helps to ventilate the patient with the bag and mask.

Someone rushes to alert the other doctors who are in handover, and soon, more senior doctors pour in, and take over. Within minutes, the patient is relaxed, and has a tube put down his throat to help us ventilate him easier.

In between the shots of adrenaline and other emergency medications that are called out, we defibrillate the patient, delivering an electric jolt into his body to try and force the heart back into its correct rhythm.

"Charging!" shouts the nurse manning the defibrillator. "Stand clear!" comes the shout once the charging is done. There is a surreal moment of inactivity and silence as we all drop what we are doing and stand away from the patient.  

His body jumps of the bed as 150 Joules of electricity course through him.

We looks at the monitors. His heart is still displaying a poor rhythm.

Doctor after doctor, and nurses have taken turns to pump away at the young man's chest. We have used up a whole array of life-saving medications in our arsenal to try and will this young man back to life.

The senior consultant walks in, and she takes the ultrasound machine to the patient's heart to quickly see if there is a collection of fluid around his heart to explain a lack of response to all our efforts.

There isn't any.

The History

A walks out to the family quickly to try and get a story, and comes back to report that this man was actually here visiting his sister and cousins from F, and he had been here for a month.

He was playing soccer this evening when he had collapsed on the field, and had what looked like a seizure on the field. He was then brought to our department where he was initially conscious and talking before he suddenly lost consciousness.

We give our best efforts in trying to save this man, especially because he was so young. We continued CPR, but a host of medications and multiple shocks to his heart did nothing to bring him back.

The Most Difficult Thing In The World

It was about the hour mark when we called in the family, three male cousins who had just been playing soccer with him that evening.

Loud exclamations of prayers leave their lips as they walked into the cubicle. They struggled to understand the sight before them - their cousin, who was laughing and kicking goals all evening was now lying limp in the bed, dying - lines and tubes coming out from him everywhere.

We continue CPR for another fifteen minutes in their presence, and the senior consultant reaches for the ultrasound and checks his heart again.

She looks up. "I am sorry," she says. "We have tried everything that we could - we have given him multiple shocks and a whole heap of medications and called the specialists about him. We have done everything that we can for him, and he is not responding to our efforts."

"What do you mean?!" one of them protests, a little too loudly. "You can't stop now!!"

"People whose hearts stop beating for a long period of time will suffer brain damage, and even if we do bring him back now, we will not make a meaningful recovery."

The other two cousins look on, unsure how to react.

"Oi,_____!" they call out his name, and shake his left leg. "(Wake up, ______! Can you hear me, woi?! Stop fooling around, man! It's time to wake up! Wake up _____!)" they shout in their native tongue.

It was an act of disbelief and desperation as their minds struggled with this new reality.

"He is no longer alive," the senior consultant says gently. "I am really sorry for your loss."

""You can't give up now! You CAN'T give up now!"

The younger doctors and nurses step away from the patient, their heads bowed.

There is an uneasy silence in Resus Cubicle 1. It is almost a sacred silence.

"He's still breathing, but," they say as they watch their cousin draw in deep dying breaths.

"Yes, dying people do that sometimes," says the consultant again, gently.

The doctors and nurses trickle out of the cubicle as the consultant explains to the family what needs to happen from this point on.

The three cousins then push past the curtains, and begin the eternal journey back to the interview room full of other waiting family members to tell them the bad news.


What Happens After

The doctor walks past the interview room back to his working area, and his steps are interrupted as a primal cry of grief escapes the doors as the news is broken.

He gulps.

He sits down, shaken. This young man's parents, who were several continents away, were about to receive a life-changing call that night.

There is a different atmosphere in the Emergency Department - a mournful, respectful air - as the department quietly grieves for one who had died so young.

The family in turn visit Resus 1 to say their final reluctant farewells to him, and the grief is most palpable in the plaintive sobs of his sister.


The doctor goes out to the front desk again. A is standing behind him.

He and A goes back several years now, and A is a top-notch doctor, fully committed to his job, and had brought many patients back from the brink of death.

Not this one, however.

The doctor turns around and sees the vacant stare in A's eyes as he considers what else we could have done to save this young man's life. He can see A's eyes glisten with moisture, and he cannot be sure if it is tears of grief, anger at the helplessness of the situation or resignation.

J is nearby, and sees A, too.

You want to go for a drink after this? asks J.

Hey, A, you want to go for a drink after this? asks J again, as A does not reply.

A snaps out of his meandering ruminations, and manages an Okay. There is little time for what-ifs right now, as A has to tie up the loose ends with all his other patients before leaving work tonight. 

The patient was twenty nine.


I think about my thirtieth birthday, a week ago to the day. And I am at a loss as to why some of us are allowed to live on, and others don't. 

I think about medicine, and I think about the doctors, nurses, and paramedics who have to deal with death at work, and then grapple with living once more when they get home.  

Who knows when our name will be called home again. May we brave and honest enough to look at our lives, and be completely happy with how we are living it today. 

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