Sunday, June 27, 2010

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.

20 comments:

Gehan said...

damn..! that is powerful stuff.. i can only imagine how that must have felt.. :S

Hoot-a-Toot said...

Owww A really tight hug sweetheart. Think of all those lives you DO save. Think of all the people you've made happy by keeping their loved ones alive.... (my name may sound strange btw...but you do know me)

Dee said...

wow :(

santhoshi said...

Hugs angel.

Scrumps said...

I can't even begin to imagine how it must be.

Written beautifully as always.

Delilah said...

must have been awful :( but sounds like you tried your best and he was lucky to have you at the end.

Heshantha said...

Oh... Dear Angel, You cannot give life to them as you are not God... all you can do is treat them and prescribe medicines and let God work on the patient... and in the mean time you have a responsibility to strengthen the patient's mind with courageous words... therefore sometimes you have to lie.....

So I think it's not a big deal... Just think of how many lives you secured..... By treating them... Just forget about the people die in your hand... you've done everything.... but God failed them.... It's not your fault...

Keep up the good work!!! Continue to save lives...

Azrael said...

Wow...

Yep, keep thinking about the ones you save

PseudoRandom said...

I know this isn't what most people will tell you, but please...don't ever forget how you felt. Far too many doctors and nurses around the world get so caught up in the rat race that they forget that a patient is not just another statistic. Don't let go of the human touch that you clearly possess.

I know it's hard, but when their time is up, their time is up. There's nothing anyone can do about it. Anicca vata sankhara, remember? :-)

The world is a better place thanks to people like you, Angel.

Chavie said...

I still remember the day my aunt came back from her first death. I had never seen her like that, and it was really shocking for me.

Like everyone said Angel, you do a lot of good and it's only natural that some don't make it while most of them do. Life is fragile, and I guess you should be really happy about the lives that you do manage to save. And the fact that even till the dying moments, you guys care and do try your best to save the patient.

*hugs*

Angel said...

Gehan, Dee, Santhoshi, Scrumps, Delilah : thanks so much!

Hooty : I know you!!! and thanks sweetie...

Heshantha : I have learnt that lesson... sometimes we need to lie.

Azreal : you know, those are so much fewer... :S

PR : you're right... many in our field get desensitised... and I think there may be an element of psycological defence... Thank you.

Chavie : that feeling is the pits. Hugs!

Jack Point said...

This writing packs a punch.

Book Baker said...

I don't even know what to say.. Except nod my hed at what Chavie said. . :( a

cj said...

wooow Angel what a powerful article. I am just stunned and speechless and moved by your words. Woooow!

Lady divine said...

I agree with everyone else... this must be really hard...

I'm sure you'll always feel it and remember it... but also think of all the good you do...

*tight hug*

mahisshi said...

Angel, this is tough!
But I must say, I cannot enough appreciate all that hard work by doctors. May the force be with you!

Knatolee said...

Angel, you are quite the writer. That was gripping. I have such admiration for you and your work!

My friend had a co-worker who died in a similar way, with an undiagnosed ulcer that went very wrong. :(

Funny how people sometimes know that their time is up, isn't it?

Angel said...

Jack, Book Baker, CJ, Lady D, Mahissi : Thanks so much for your encouragement

Knatolee : It's funny, but maybe some people "just" know.

gutterflower said...

Nicely written. Felt as though we were there with you.
A bit late to the party, and everyones said what I wanted to say. So at the risk of sounding repetitive, remember that you're only human, after all.

Hugs.

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