“Wai Jia. CPR. Now.”
Those are the words I dread to hear at 3am in the morning, especially during a 30-hour on-call shift at the hospital.
My mind went blank as my hands and body mechanically pumped life (is that what you call it?) into a lifeless, pulseless frame. It was backbreaking. She was 200 kilograms, a stout Michellin figure with her body spilling from the sides of the bed, breathing quickly with shortening breaths before she suddenly collapsed.
“Dr Tan, can you see this patient? She is complaining of breathlessness.”
Breathlessness. Hypotension. Chest pain. These are the three symptoms one should never overlook or put aside. They can be benign, but could also be ominous signs of impending doom.
“Oh, but doctor,just to let you know, she has been like that for a long time. This is her baseline. Just letting you know only.”
It was my fourth consecutive 30 hour shift in two weeks. That was the phonecall I wished I’d never received.
It was three in the morning, exhaustion tied my legs down like lead. She was still chatty, telling me that she had a little tummy discomfort. I alerted my seniors. They came immediately. Her son was by her bedside. I drew blood from her wrist for investigations. Shortly after I did, she collapsed. And I blamed myself for reaching there too late.
“I’m sorry, sir. Please wait outside.” Those were the words that I said to her son.
The resuscitation trolley came. A mob of senior and junior doctors from various departments and nurses surrounded the patient. There was a riot of activity.
“Set a plug! “
“Can you get a vein? Where’s the adrenaline?”
“We need a bag mask. She needs intubation!”
” Is the pulse back yet?”
” Call the ICU!”
” Get an urgent CTPA scan!”
There were at least ten of us there, pumping, injecting, calling, cursing-all trying to pump, push and spur some life back into this frame. I was ridden with guilt. Had I reached there earlier, had I informed my seniors earlier, would things have changed? Could she have avoided this ignominious collapse?
After a fierce resuscitation, with a hundred tubes linked from her limbs and face, she died, four days later.
It was dejavu all over again. Just 4 months ago in a previous department, I struggled with the guilt regarding another patient’s management while I was on call. She died, too.
It was then that I remembered the words of a missionary doctor I had met in africa, who shared with me his take on life and death. ” You did not kill them, you merely failed to save them. And there is a big difference in that.”
And as the more senior doctors would say, not everyone can be saved.
The senior doctors I approached said the same thing- that she would have passed away, sooner or later- she was a ticking time bomb as she had refused further investigations days ago and was too large to fit into the CT-scan machine. They told me, had I reached there earlier, it would not have changed the outcome. In fact, in a way, they said, it was somewhat fortunate that she collapsed while we were at the scene.
“Don’t blame yourself.”
As physicians, I think we all self-impose the responsibility of saving lives. When we fail to do so, we inevitably blame ourselves. And I think I won’t be wrong to say, that every long-enough practising doctor has experienced guilt in his or her career.
Her family never blamed me. “I know, doctor, you are also very shocked. Our family is also very shocked. It’s okay, don’t blame yourself. We do not hold any grudges.”
It took me a long time to get over it. I checked on her daily at the Intensive Care Unit, seeing the mechanical ventilators pump air into her lungs. They never came to a diagnosis regarding her condition, because she was too large to fit into the CT machine.
One day when I got there and saw a different patient in bed instead, the doctor told me, “Oh, she passed away. Her heart didn’t hold up. Atrial fibrillation. Likely a second Pulmonary embolism.”
I am learning, that life and death is in God’s hands, and we need to trust, that we are tools in His hands to bring light, help and love among people. When that is not possible, we need to trust, that we are tools in His hands, to bring comfort and support to those grieving. We need to trust, that often, things lie beyond our control, and sometimes we just, need to let go. He is the decider of life and death, not us.
There is a time for everything.
Ecclesiastes 3:1-
A Time for Everything
1 For everything there is a season,
a time for every activity under heaven.
2 A time to be born and a time to die.
A time to plant and a time to harvest.
3 A time to kill and a time to heal.
A time to tear down and a time to build up.
4 A time to cry and a time to laugh.
A time to grieve and a time to dance.
5 A time to scatter stones and a time to gather stones.
A time to embrace and a time to turn away.
6 A time to search and a time to quit searching.
A time to keep and a time to throw away.
7 A time to tear and a time to mend.
A time to be quiet and a time to speak.
8 A time to love and a time to hate.
A time for war and a time for peace.