I have been there several times, wresting a poor soul (in a diseased body) from being crunched and finished. With about 50% success rate. Some have just slid and slipped into the slimy bowels of Death while others have landed back with a yank, like in a tug-of-war game!
I call these near-Death-experiences; of the Doctors’ kind!
It was a month end Saturday and we were at a CME (Continuing Medical Education)meeting when my colleague had to leave as the ambulance came for her. I knew-if she has to go, then my call would not be far behind. And so I had to go too, at eleven in the night; into a deathly silent operation theatre. For the patient was so far nearly-dead that it was doubtful if she could even survive till she got shifted from the gurney onto the operating table! Her tubal pregnancy had ruptured, spilling all her body’s blood into her abdomen, leaving her parchment white with an unbelievably swollen tummy.
But we had to take a chance (an optimistic misnomer, for we were taking a huge risk) and operate on her. Just then she threw a violent fit, signifying that her brain too was finally giving up! The anaesthetist survived her own heart attack only because she had to resuscitate this patient! Let’s call in her husband and let him see her alive one last time… we called the teary eyed man, right inside the operating room. (Normally, people are not even allowed into the ante room. But we made conscession for him because we were so sorry) She was now unconscious. I can never forget how he came in, sobbing and slumped, and went and touched her feet in all reverence and sadness!
I have still not figured out why some people die despite the best efforts and why some people bounce back when we have almost given up! Like this patient, who went home well after a week’s stay in the hospital! She was one whom we literally wrested from the jaws of death.
Not so miraculous for this woman, almost of same age, who died in my arms in the surgical wards of St. Martha’s Hospital. I was Senior House Officer (SHO-another misnomer, because SHO is the most junior, post-MBBS staff in any unit) The senior doctors were in the OT or elsewhere unavailable and the middle rung were having lunch. I was slogging it out in the wards, writing case sheets and discharge summaries when another green horn- a nursing student came running and asked me to attend on a patient.
I knew nothing about the case as she wasn’t in our unit. But the fact that her cot had been cordoned off from view of the rest of patients by the green foldable screen meant we had a not-so-optimistic situation here. I had just been to her side and started with the preliminary exam of pulse and BP and enquiring what discomfort she had, when she, already in a propped up position, lurched forward. I supported her back with my left arm and thought she was about to throw up. Even as I looked around for a kidney tray to place at her mouth she outstretched her arms forward. I can never forget that wild look in her eyes-unblinking and pupils dilating; or the desperation of are-you-letting-me-go? expression on her face! The next second with a hoarse whisper, she slumped back on the cot, my left hand and arm between the mattress and her dead torso!
To be fair to Fate, I have been lucky at times, to get just those few precious minutes to do a CPR. An elderly muslim man was undergoing surgery for Cancer colon, when he had a massive cardiac arrest in the midst of surgery. The surgery was cut short by resorting to a faster but less definitive procedure, after informing his waiting relatives. They sewed him up fast even as the anesthetist struggled to keep him alive. “Go with the patient to the ICU,” I, the SHO, was ordered. The medical ICU was in another building and I had to run alongside the trolley pumping the Ambu bag (pushing oxygen into his lungs). I remember sprinting out from the OT, down the ramp into the 11 Am Sun, across the open courtyard and then into the waiting open doors of ICU. He had another cardiac arrest as we were shifting him onto to the cot. The next moment, I was thumping his chest. Maybe the power due to my desperation or his weak ribs, I could feel a couple crackle under! I still persisted and he was back breathing… and later, his two broken ribs did not hamper his course of disease! (‘You broke his ribs during CPR,” they had told me. “I know. But he had to have the best chance or you would’ve pulled me up!” I had retorted!)
I do not know about the current syllabus, but we never had formal, practical classes in resuscitation! A handful of us though, got ourselves trained by the St. John’s Ambulance course in First Aid and Emergency. And when as house-surgeons, we roamed tutorless, in the over-crowded emergency wards of Victoria Hospital, no one would ever ask us about any of our acts of commission or omission. And so when a young man, from the slums, and of about 20 years started gasping, we began CPR and mouth-to-mouth even as someone ran to fetch a senior doctor. Only two of us-Dr. Jai Ranaganath and I volunteered to give mouth to mouth while some others were content with thumping the heart. The boy was yellow- buck teethed and was the mouth-to-moth a memorable experience! Covering my mouth completely over his and blowing in; with a thin green-chequered cotton handkerchief in between! By the time some senior doctors took over, the two of us were looking around for somewhere to throw up!
Some patients somehow manage to stay in a hospital for weeks and months at a stretch. They are often homeless or disowned. There was one such middle aged, jaundiced man in the Medical wards. He was in a corridor cot. (As a rule, the overflow beds are put in the corridors which actually become a thoroughfare ward!)The senior doctors would casually pass by his cot as if he were an inanimate fixture like all other dilapidated furniture and the juniors would scribble ’repeat all’ in doctor’s orders, everyday in his case sheet. The ‘repeat all’ would be a small b-complex tablet-one a day.Such patients stayed in hospital not for the insignificant B-complex but for the free food and lodging that the Hospital offered!
With a constant influx of junior doctors, no one really knew what his case was or even cared to asses him daily! I was in my final year of MBBS. One morning, when I went to the wards, earlier than anyone else (because my only bus came early, I would be the first doctor in the wards), an experienced male nurse came running and said-“That corridor bed patient is dying. Come quickly!” I did not know what to do but followed him. At that stage of training I only knew about intra-cardiac adrenaline (Injecting adrenaline injection directly into a heart hoping it to restart-often a last resort.) But with woefully limited supply of essentials that was the only thing I could manage. “Go ahead, give it. If you know the technique,” the male nurse prompted, thrusting an adrenaline-loaded syringe into my hand. Despite years of experience he had not given one previously! ”Of course I know the technique,” I said even as I was thinking what I would answer to the Unit chief and the Head of Department…Anyway, no one ever bothered about this patient (including chief) and if I revived him, it had good chances of going unnoticed, let alone applauded or even reprimanded!
For the first time in my life, I drew blood straight from the heart and pushed it right back with adrenaline! And sure enough, as described in books, the heart bounced back into action. “This is the first time in my service I have seen an intra-cardiac adrenaline work, Doctor,” the nurse said, this time not forgetting to add doctor. For my part, I knew I had to thank only adrenaline for it, for I did not know what else to do had it failed! The guy stayed alive, still ignored, even when I finished my Medicine posting and left the wards after six weeks.
I have had near-Death experiences with people closer home too. My mother-in-law was in the ICU for over 2 weeks. Her condition was still precarious, but stable, when she was shifted out of ICU. Less than 24 hours later, as I entered her room at mid-noon and went to her side to ask how she was, she began gasping and the next second she stopped breathing. Her sister who was also next to her started weeping aloud as I began CPR and shouted out for help simultaneously. As she was in the hospital bed which had wheels and as the ICU was only a few rooms away, she was immediately wheeled off. She was revived after two D/C shocks!! And survived for another seven years. With one another near death experience for me, this time at home!
She slipped and fell after dinner one night. We helped her onto her cot and the next second, she stopped breathing. Though a physician and definitely better knowledgeable about resuscitation than me, my husband began reacting as a son than as a doctor. He became emotional and refused to come close. That left me to do the job. Sobbing, I thumped her chest hoping I wouldn’t break ribs this time and then giving mouth to mouth. Nothing for about a minute. Her lips were becoming blue and she was pulse-less. I slapped her face, wiped my tears and got back to CPR. The next blessed moment she sputtered and came back to life. “Why are you shouting and slapping me?” were her first words!
But three years later, when she had an attack at home and I accompanied her in the ambulance, she told me, with her oxygen mask on, “ Give me your word…Don’t resuscitate me this time. I can’t live any longer. My body is too battered.” And two days later, in the ICU, we let her go. We consented for no-artificial Life support….
As I have said, I have failed 50% of the times too. As house-surgeons in Department of Surgery, we were expected to look after the burns wards during casuality duty. Mahabodhi Burns Centre was in the first floor and we would get calls when a burns patient just got admitted. We were expected to hold forte till the seniors arrived. The basic resuscitation of starting an IV line is very difficult in burns patient. The body is burnt and so are the tissues. In such states of shock all the veins are collapsed and we have to resort vene-section or exposing the veins and then starting an IV line. Patients die even as we struggle to get a vein.
And then I had a boy of eighteen brought dead due to drowning. A&E room, Tamil Nadu Hospital, Chennai…Wet shorts, wet vest and dripping hair. Fresh and pale. No need of resuscitation!! One of the death certificates I had to write…and suddenly in the midst of writing, I remembered ‘suspended animation.’ When people drown or have an electric shock, the body shuts itself off and is not really dead. It might be worth trying to resuscitate them .I jumped back and re-examined the fellow. He was really dead…and then I noticed froth at his mouth (had been wiped off by people when I saw him first)…Pulmonary Edema…I noted, with undying memory of his pale, cold skin; as I went back to complete the D/C.
The elderly man who had a cardiac arrest during surgery, stayed in the hospital for a further 6-8 weeks before dying, this time in the surgical ICU. I saw him off with a senior doctor; both of us and the attending staff struggling in vain. He declared the man dead to the waiting relatives outside and relegated to me the duty of writing the death certificate. And I sat in the ante room writing, with over a fifty male relatives of the dead man murmuring and waiting restlessly outside, the surgeon came in and asked-“ Are you certain he is dead? Did all the resuscitation,eh? They won’t spare you if he came alive on his way back home,” he pointed outside. Just as I was about to run back and confirm, he said, “Relax. I wanted you to realize that you must always do everything possible to fight death!”
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