First death

Somehow, I think that is something that really affects all doctors... the first time someone dies on your watch.

Mine was a few years ago and I still get flashbacks... still remember locking my self up in the teaching room of our ward and retching over and over again until there was nothing left to throw up. Still remember sliding against the cool wall until I was seated on the floor, alone in the darkness, hot tears burning my cheeks and whispering "I'm sorry" over and over again. Still remember it taking the best part of an hour to stop shaking... and then walking out, completing the night round, calmly writing out the death certificate. Still remember going home in a daze, walking into the shower, clothes and all. I threw away those clothes - they were so soaked in blood I don't think anything short of a blade would have gotten the stains out.

Since then, I have watched scores of people breathe their last, closed their sightless eyes, talked to hysterical relatives and filled out the forms over and over again. Death no longer has the power to shock... but the awe still remains. And so do the memories. I remember every. single. one.

That fateful night was a Saturday, and the patient was Rupasinghe* a transfer from Dambulla, who had a couple of episodes of blood stained vomiting. We had scoped him the day before and found an ugly ulcer in his stomach, probably cancer. I had explained about the surgery to him, told him about eating well and getting his strength up and informed the anesthetist to do the pre-op prep.

Sometime during the ward round I heard a hoarse shout from the toilets... and I remember running into the patients' toilets and finding Rupasinghe lying on the ground... he mumbled about passing blood with his stools, and started to moan. I'm not sure how, but I had him out of there and almost onto a trolley by the time the attendants heard what I'm sure were my semi-hysterical shrieks and came running.

One look at his eyes and tongue was enough to confirm what I feared - he was as pale as a sheet of paper and that meant the ulcer had eaten into a blood vessel and he was bleeding into his stomach, so fast that fresh blood was coming from the other end. Rupasinghe clutched my hand, and asked me if he was going to die... and I said something soothing, and told him we'll be taking care of everything.

My senior was there in minutes, and we started pushing in pint after pint of blood, saline, and starch - me on one side, a nurse on the other, squeezing the blood packs to push the fluid in faster. Suddenly R started gasping and before any of us realised what was happening, a gush of blood fountained out of his mouth, drenching my white blouse. The cold hard realisation that this man was going to drown in his own blood terrified me. We pushed a tube into his mouth, and fixed it to the suction machine, removing the blood as it welled up. More doctors were called in, more blood and more fluid, all of us working with silent, grim determination.

And then he improved... blood pressure started climbing up, and he opened his eyes, staring semi comprehendingly at the drenched sheets. I told him not to worry... that everything was under control... and we kept on with fluids. I remember smiling at my senior, and wondering why the relief wasn't showing in his face. Then Rupasinghe clutched my hand again and said, "I'm going to die doctor". I shook my head and managed a smile and said no, that's not going to happen, things will be ok.

He looked straight into my eyes and gasped out "you doctors are such liars".

Those were the last words he spoke. Less than a minute later, he started vomiting blood again, and this time, we couldn't stem the flow. Deprived of its lifeblood, his heart stopped, and CPR was just a futile exercise.

And looking into his sightless eyes, all I could hear were those final words, clanging over and over again inside my head, each syllable a skewer through my consciousness.