What we go through
There was this lady in her sixties. She was admitted just before my 15-hour long shift started. On the wee hours of a Saturday morning.
This entry is filed under Doctors and tagged death, favourites, love. There are 11 responses to this post.
There was already talk about her even before I met her, as the first most important patient of the morning. Severe bilateral community-acquired pneumonia with a fast downward spiral.
Put on BiPAP, 10/4 setting. A femoral artery stab for blood gases, because her radial pulses were already too weak. Another 18G cannula into her veins. 1 litre of 0.9% sodium chloride solution, stat. The glucometer read 2.0 mmol/L — give her 20mL bolus of 50% dextrose intravenously, now. And an indwelling urinary catheter. Two doctors and three senior nurses danced around her.
Her husband sat beside, in the corner of the room, silent.
And I realized how used to all of this I am already – even joking sometimes as we flashed needles around, shamefully forgetting how scary, and confusing, it must have been for him.
She had a good pre-morbid status, so she would be a candidate for the Intensive Care Unit. We spoke to the ICU consultant. He was a staunch man with a deep voice and a strict face, who hasn’t slept for more than 24 hours. It had been an absolutely crazy Friday night and Saturday morning that we walked ourselves into. He promised an ICU bed for her — but then a child was wheeled into the Emergency Department very sick, and priority was given to the child for the ICU bed, as less would disagree with. The bed was taken. She was now at the ceiling of her care. No more escalation.
We told her husband about this. It was difficult.
And I wondered… how did he think, to know that his wife was terribly ill, and the one thing that would sustain her if she deteriorated — a mechanical ventilator in the Intensive Care Unit — was just not accessible, as the Intensive Care Unit was already full?
What would you think – when you are helplessly slipping towards crossing the moment between having a life partner and no longer having one?
Is this it?? But yesterday she was still fine! I’ve only just done grocery shopping with her yesterday!! Am I not going to see her again, for ever??
What would you say to your life partner during his or her last moments?
Recount all the good times?
Recount all the regrets and mistakes?
Say the things you never could say? Does it still matter?
She continued to deteriorate. Type 2 respiratory failure with worsening hypoxia and hypercapnia over the hours of the day, despite us adjusting the EEPV and EIPV settings with all the hope we gave.
And then, at about 10pm at night, I got called by the nurses. They just wanted a doctor to be there beside her. But I have no magic wand; I am but a mere human.
She was apnoeic. She stopped breathing. And then she struggled with a big gasp.
Her husband and son were there, one on each of her side by the bed, in the dimly lit room. Agitated. Panicked.
The nurse pushed me from behind into the room. “Have a listen to her heart and say something,” she whispered like a little sister. So futile. But what people would want in desperate situations.
I listened with my stethoscope, and there was no heart beat. But wait, there was one radial pulse… and then, one duplet of heart sounds after five seconds… and then another one after another four or five seconds. I’m sure if we did a rhythm strip then, it would have shown ventricular fibrillation or an agonal rhythm with the occasional sinus complex. It was terminal.
I raised my head up — and I can still remember so clearly, even now — the husband and the son looking at me in absolute desperation.
“Is her heart still beating?? Is she still around??” they asked.
“These are the last few minutes,” I stuttered. Not loud enough. Not clear enough.
“Huh??”
“These are her last few minutes…,” I said, louder. And I didn’t know what else to add. That was probably all they needed to know.
I left. And as I turned my back to them, I heard them cry.
“I love you. You know I love you,” her husband sobbed.
Her son was a big guy but he was drenched in tears. He had his arms around his father and dying mother. “You’re the best mom in the world,” he said, his voice trembling.
I stopped just outside the curtains. I didn’t expect this to have affected me so much. I paused a moment to recollect myself. I hate people who call doctors “cold-hearted” without even knowing what we go through.
And she passed away seconds later.
I still wonder what I would have said if I was the husband, and what I would have said if I was the son. And then I realize those are the exact words that I may very well have said too, from my heart. They resonate deeply within me.
And then I got sick with a cold (again), and in the following weekend, at church, there was an announcement of her passing away to meet the Lord. So she was the wife of a deacon in one of the other churches, I didn’t know. They recounted how loving she was, and the kindness she showed to the ones who were often neglected by others.
The events of my shift played back in my mind as I listened to them sharing. Unbeknownst to the people around me, I was right there when she died. I was directly involved in her fifteen-hour admission to hospital — I was there when the needles were put in, I was there when she drew her last breath, and I was the one who felt the last beats of her heart.
Everything played back — and I asked, but what could I have done? Could I have done anything differently? Was I respectful enough (a lesson from this experience)?
Well, I could have (and definitely should have) spoken clearer to her husband and son during her final minutes.
I suppose, in a way, it is a privilege to be so deeply involved in someone’s care, but it is not heroic at all. We are all just fellow humans who are lost without God.
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oming to you
from a junior doctor who is color-blind, cleft-lipped and left-handed — this is where
I largely write about my
somewhat weird and wonderful encounters in Medicine. I wish,
though, more often than not,
that I could rather spend my days
drawing colorful pictures and bringing stories to life...... -
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Thanks for the wonderful, inspiring reminder of the same journey we all are on.
My daughter is a palliative care phyisican near Boston and I am sharing this with her.
I just read below…, you did draw a colorful picture.., in words.
hi John, thanks for the kind comment! i’m glad you enjoyed it ;)
may i ask out of curiousity how you came upon my blog?
*nod* *nod*. I guess that’s an experience that all doctors have to go through. Thanks for sharing
wow what a powerful piece you have shared… you do have a gift of mercy Joseph. You might regret you didn’t do or show enough compassion at that point of time, but you really do in the depth of your heart. And guess that’s what matters the most… to the patient, the family, and to God.
gift of mercy… not so sure about that, seriously….haha -_-
Your post has definitely gotten me thinking. Especially your questions. I need to spend more time with my wife, and tell her more often how much I love her.
What you’ve described reminds me of some of the scenes I see in Grey’s Anatomy. While I can’t truly understand what you are going through in those situations, or even remotely relate, I do know that it must be very tough, and it comes with the job.
Still, knowing that there wasn’t much you could have done in that situation should not stop you from taking action for situations you can do something about. Do keep at it! :)
i’m glad it got you thinking – just as it got me thinking too. anyways, if you do something nice with your wife this weekend and your wife appreciates it, make sure she thanks me! …. JUST JOKING. (really, i really was just joking!)
Hey Joseph I’ve accidently read this. I can feel how u hav felt sometimes too. I struggled a lot before, but I guess being emotional is not the way to go when facing the sick pt. In the situation like that being professional is actually the most helpful thing for the pt or reletives. Maybe maybe ppl call u heartless, but as long as u know u did not do anything wrong medically. God knows and understands what u have gone through, and that is enough. Pray to seek ur way out lo (we have tried, worked well)! U take care of urself, will pray for u:)
hey Ivy! What a pleasant surprise to hear from you. I can’t understand how you “accidentally” read this — what does that mean anyway?? Haha…
Um, do I actually sound that affected / emotionally-scarred by this experience? Don’t worry, I don’t think I cope too badly – a good bowl of instant noodles can make life feel instantaneously better har har. Thanks though for caring and offering to pray!
How have you been by the way? You should visit more and comment more!
This is like the saddest thing I’ve read – ever.
Uhh your story telling is good! As for the content…I still don’t know how doctors are meant to be caring yet emotionally removed/detached at the same time. I think I would explode from trying to contain all the competing feelings.
I really don’t think I can say anything that will make you feel better except that we’re all humans, not superhumans (my mentor told me that “It’d be nice if we could just wave our magic wand and make things better”). But like some of the others, I would recommend taking all your worries to God. He can shoulder some of the burdens you carry and make your load lighter :)
hahaha, I would take that as a kind compliment from someone who reads Michael Crichton. Yea and if you dig back, this blog is pretty much doom and gloom really. I try to cheer it up with some childish drawings, that’s why.
Gosh, do I really sound like I was THAT traumatized by this experience? I was just narrating the process and my thoughts/feelings — don’t worry, I haven’t developed post-traumatic stress disorder from this! thanks though ;)