Saved.

Few incidents in life leave one with the certainty of never being able to forget about them. This is certainly one of them.

It went over and over in my head. They kept telling me, that I had nothing to do with it. It was a freak event, totally unexpected, unfortunate, and not caused by me…

… But I couldn’t help but feel, that I had killed her.

That day, I left feeling as though I had blood on my hands. Could I have saved her?

It was my first tragic death, the first death of a patient I had been so involved in, mainly because I had done so many things for her in the night and wee hours of the morning while I was on my 30-hour shift. I remember going back to check on her, again and again. I remember slowing down to talk to her, to smile at her and hold her hand… I remember knowing that she was old and frail and not very communicative but telling her that she reminded me of my grandmother… but that my grandmother had passed away and she was very much alive.

In the morning, we discovered the ions in her blood weren’t balanced since the night. Hours after we started balancing them, she developed difficulty breathing and crackles were developing all over her lungs. She turned blue. Code blue, the signal for a collapsed patient, was sounded and everybody rushed to attend to her.

Electrical leads were placed on her chest to detect any abnormal signals from her heart. It showed signs of a massive heart attack. All the nurses came. The senior doctors came. I did her CPR.

Everything happened so fast. Her family was being given minute-to-minute updates over the phone. They were crying on the other side.

She didn’t make it. She died, of a massive heart attack that morning.

Her family and extended family came. They all crowded around her. She came into hospital for a completely different reason and her death was unexpected.

Because of the way things unfolded, because of how I had been attending to her in the night, because of what I felt I could and should have done between night and day before the morning team came to see the patient, I felt her death could have been prevented, had I done something more for her, replaced her ions sooner.

Could I have saved her?

The family came. I saw all their emotions. Shock. Bewilderment. Grief.

And the senior doctors came. And I told them what happened. I told them what I felt
I should have done. And they all said, it wasn’t me. It was a freak event, totally unexpected, unfortunate but not iatrogenic, not caused by me… Yes, on call that night there were things I could’ve done more… but her death wasn’t caused by me.

I went to read up about ionic balances, what could and should have been done. I just wanted to know, if her death could have been prevented. Maybe some part of me just couldn’t reconcile with the fact that I could have had a part to play in her death, but I couldn’t shake it off me. It hangs like a shadow over me, still.

At the first meeting after our graduation when our Dean addressed us, he said that as physicians, we had the license to heal and to kill. Not doing anything, could also kill somebody as much as doing something actively like pulling a trigger on a gun or slashing someone with a knife.

I cried that day. And the following days. And still do, when I think about it. Because in my head, I just felt she shouldn’t have died. Would she not have died, if it wasn’t me, but someone else who had attended to her that fateful night?

They said it was a freak event, totally unexpected, unfortunate but not iatrogenic, not caused by me. Could I have saved her?

I have had no time to grieve of late. So many things have happened since I started work that I’ve simply not had the time to reflect and grieve over the many dramatic and tragic events that have unfolded. Life and death and the tussle between both worlds happen so fast on a daily, and sometimes, minute-to-minute basis.

Mr. X’s blood pressure and red cell count kept falling over the weekend (I had to work every day last week). I called the surgeons in for him. I had to transfuse 3 pints of blood into him. I checked his anus several times for a source of bleed. I updated the family regularly. We X-rayed, scanned and scoped him. I truncated our breakfast meeting today to rush up to speak to his scope surgeons. I talked at length to his children to find out about his life, his worries, his depression, his gradual decline since the start of the year.

Today, he finally had black stools, a certain sign of an internal bleed. His scan today, also showed a mass suspicious of a lung malignancy. I broke the news to his family, that we may need to do further investigations. His son, was suitably shocked. “I’m sorry to inform you about the news. Please let me know if there are any questions I can answer for you.” It felt like a broken record to say. I could not begin to put my feet into his shoes.

Next to Mr. K is Mr. T with a stroke so massive he can only speak in confused terms, with trouble understanding and expressing himself, though his limbs are regaining strength well.

And then there’s Mr. R, who doesn’t seem to really care if his scans show a tumour because he seems to know already since he’s been so tired all this while. His son and wife can’t stop him from drinking.

Mdm Y has 4 children but I’ve never seen them visit her.

Mr. W demanded to be discharged today because he was unhappy with the standard of care he was given.

I went to another ward to look for the nurse I felt I was rude to when I was on-call the other day so I could apologize to her but she was not around.

Day in day out, these series of events happen, one after the other. All of this, happened only today. Imagine this happening, day in day out, every day.

Today, I’m tired. It’s no wonder I’ve been having dreams about myself constantly running and looking for something. That night before Mdm T died and I had had a short nap from 5-6am after having worked continuously for 22 hours without rest since 7am the previous morning, I dreamt that I was carrying a bag of blood to a patient who really needed it. I was running and searching and couldn’t find the patient… and it was useless anyway because the blood bag had a leak and all the blood was leaking through my fingers… And by the time I discovered the empty blood bag in my bloody palms, I couldn’t remember where the patient was. It was a dream. I woke up. And Mdm T died that morning. I failed to save her.

This is why I am so self critical- In medicine, it doesn’t matter if you’ve done 9 things right for a patient. Sometimes, it only takes 1 omission or 1 error, to cause irreversible harm. That’s why I keep looking for that one fatal incompatibility in relationships, even though there may be 9 other compatibilities- I just don’t want another unexpected death.

At least now I know, that Internal Medicine as a lifelone specialty is not for me. So many doctors were suggesting to me to join their geriatric or palliative team (a part of Internal medicine). They said I would make a great doctor on their teams. But I don’t want this drama, day in day out. I’m so glad I know what God wants me to pursue now.

Maybe it’s just an excuse that I say being in a relationship will distract me from my calling, because the truth is also that, I’m tired. I don’t know what to say at the end of a day after seeing death and illness and tears and anger. I don’t know what to say when my seniors have done their best and still have patients’ relatives who want to sue. I don’t know what to say at the end of a day after realizing I have my own life to live, after leaving the many lives back at the hospital. I don’t know how to hold a conversation or go out on a date pretending that everything is okay and that another day just ended.

My period hasn’t come since I started work. It’s just one of the physical markers which tells a woman her body is stressed beyond a suitable level. The only other times I remember missing my period was when I lost too much weight when I was ill. My gums around my wisdom tooh have become swollen and made eating a painful activity- they only swell during my exams when I’m subconsiously stressed. The 30-hour shifts, daily grind and host of events have finally proven to be a challenge.

And it only goes to humble me and show me, how as hard as we try, truly, we are fallen people, just as in need of being saved, and saved only by grace.