a.k.a. Why I don't like my job
Mrs. P walked in one busy Saturday casualty, smiling apologetically. "It's only my wheeze, doctor. I got nebulised at the OPD but they said to get admitted anyway." She was breathless and a brief listen at her chest showed basal crepitations - the signs of heart failure. She was made comfy in a bed close to the nursing station with the HO insisting on oxygen... the registrar okayed the drugs, added another and casualty went on... hectic as usual.
It was close to 2 a.m. when the nurse came and told me that her blood pressure was on the low side. A drip was started as well as another drug. I wasn't happy because we couldn't attach a cardiac monitor... there were 3 admissions with heart attacks and there simply wasn't a machine to spare.
So I kept an eye on her, going up to her every 10-15 minutes "how are you feeling Mrs. P?" - checking and recording her vitals. Her lungs were clearing and the BP started going towards normal. She was feeling better and talked briefly about her kids and why there was no one with her because someone had to be with them. Everytime I left her bedside she smiled and said "Thank you, doctor."
It was just past 3am when we had a new admission, an old lady literally vomiting buckets of blood. I had never seen haematemesis that bad. The BP apparatus was in my hand so it was just a matter of turning from Mrs. P to the next bed, checking vitals and asking the nurse to take blood for grouping and matching before sending saline in fast. The old lady's daughters were there, both attendants at the hospital and both screaming and wailing like banshees... they kept embracing their mother and I had to practically wrestle my way past them to adjust the drip. It took the HO telling them very firmly to be quiet and calm down before we could continue with taking a history, giving medication and writing out the forms for blood and plasma.
I remember glancing at Mrs. P at some point during the melee. She seemed comfortable and was breathing ok. It was about 15 minutes later that we got the old lady stabilised with a blood transfusion and things had quietened down somewhat.
I walked over the few steps to Mrs. P and just went cold. She was lying on her back, eyes open, pupils dilated. The oxygen mask had been torn off and was in her hand as if at some desperate attempt to breathe.
I barely checked her carotid pulse before launching into CPR, calling out to the HO and nurses. Tubes were put in and a cardiac monitor (unceremoniously removed from another patient who was "stable") attached - flat trace other than the spikes due to my cardiac massage. Adrenaline was pushed in, then other drugs, over and over, while I kept mumbling please, please, please hoping that any God, anywhere, would show some mercy. We tried for close to an hour until the HO gently told me what I knew all along... there's nothing more we can do, she was gone.
I closed her eyes, and listened one last time with the steth. The monitor was removed and re-attached on the first patient. Fighting tears, I wrote down the needful on the ticket.
No central pulse
No heartbeat, no respiration
Pupils fixed and dilated
Death confirmed at 4.20 a.m.
She was only 42 years old.