When it happened, I remember having that feeling of my brain being frozen, as if my mind wanted to return to where time had been. Every cell inside of me was stiffening up- from fear, shock and disappointment, but everything outside of me demanded 100% of my energy, agility and focus. She was my patient, and I was her primary doctor.
“Urgent CT scan. Now. Why wasn’t this done earlier?”
“Call the neurosurgeons. Now.“
” Where’s the patient’s family. Update them now.“
Now. In the Emergency Department, this word has serious implications. Now means what it means. Instantly, immediately, as soon as you can, dropping everything else. There is no time to waste. Something is happening as time slips by, and every move made, wrong or right, may have implications on someone’s life.
GoGoGo. Even though every part of me wanted to stop, just stop and think all this was just a bad dream, and every part of me wanted to go back to the beginning, I could and would not.
Just minutes ago, she was perfectly sound. Calm. Alert. Oriented. If anything, she just looked a little teary because she couldn’t quite remember what had happened and was a little worried. But other than that, and her sister who seemed very concerned, she looked stable and fairly well. I got her history from her colleague over the phone, who told me she had brought her in because everyone noticed her staring straight ahead blankly during an office meeting, before she started drooling and sliding off her chair. That was all.
A seizure, perhaps. I thought. Inform my senior, do a brain scan, admit to Neurology, update the family. Things would be okay, I thought. Her blood pressure was a little high, but many people have high blood pressures.
“Don’t worry for now,” I told her sister. ” We’re just doing some investigations.”
I was supposed to take her bloods and send them off for tests. But she needed to use the bathroom, so there was some delay. “Please, doctor, just one moment.”
Just as I was about to set the intravenous line, I then realized she was no longer talking to me. Instead, she was staring ahead blankly, and breathing heavily.
Oh no. Another fit, I thought. Resusitation room. Send the patient to RESUS. NOW.
The Resusitation Room. The place where deaths occur every day, where lives are being saved, where trolleys of people, clinging to the edges of life and death, get wheeled in and out on a daily, even hourly basis. Some of them are corpses. Lines, oxygen tanks, needles, machines and medication trolleys line the entire room.
Her sister looked bewildered. “Where are you taking her?”
“She’s deteriorated suddenly,” I said, ” We’re sending her to a special room. We’ll keep you updated.”
Although she was merely just staring blankly ahead, I knew it was another seizure attack.
“Where’s the brain scan? Send the patient for an urgent brain scan. Now. But Wai Jia, prepare diazepam and go personally with the patient for the CT brain scan, in case she throws another fit.”
“Yes sir.”
As the nurse and I wheeled the patient’s trolley down the catacomb of corridors, my mind froze as I wondered what could possibly have happened. First episode of seizures in an adult is never an innocuous sign. Yet, she had no headache, no other sinister symptoms previously except this one-time occurence of staring blankly ahead. Just minutes ago, she was deceptively well.
It was in the CT scan room where, as my senior consultant had rightly predicted, she threw a full fit, jerking her hands and feet uncontrollably.
“Doctor, diazepam now.” The CT technician was an experienced chap.
Just minutes later after the patient had gone through the tunnel, thousands of cuts of the CT appeared on screen in the dark room.
“Bleed. Major bleed,” said the CT technician, “Subarachnoid haemorrhage.”
Her blood pressure, by now, had shot through the roof. 250/160.
I felt we had lost her.
“Call the neurosurgeons.”
“Intubate the patient,” said the chilly voice over the phone. “Intubate, before we lose her completely. Book an Intensive Care Unit bed. My team’ll come and see her shortly.”
“Yes sir. Will do.”
Intubation. It means putting a plastic tube down one’s throat and supplying mechanical air ventilation because one expects imminent collapse of the patient and loss of her airway.
Within an hour, everything had changed. Her diagnosis. Her life. Her sister’s life. And in a strange way, mine.
Every day in the Emergency Department, lives are lost and saved, battles and won and lost. The worst experiences, are always the least expected ones. Just yesterday, a middle aged lady I saw who came in for “a feeling like a fishball got stuck in my throat” and some “neck pain” was discovered to have raised cardiac enzymes, a clear sign of an evolving heart attack. She had no shortness of breath, no cold sweat, no exertional tiredness. After a frenzy of activity (informing a senior, pushing her into the Resus room and calling the cardiologist), she was pushed up for an urgent PCI, an interventional procedure which unblocks the arteries of the heart.
Coming so close to life and death every day, can be slightly unnerving, to say the least.
Day in, day out, life (and death) goes on in the Emergency Department.
Before every shift, some of my colleagues share they have pre-shift blues. I, on the other hand, have pre-shift anxiety, which is only quelled by prayer and time with God. Sometimes, one cannot help but feel responsible for delays, and human errors, and death. But could we have prevented those tragic events, put a dam to the flood of irreversible damage done to these people? How do we go on in life, knowing that life and death has passed through our hands.
Mdm T, who died of a sudden, massive heart attack. Mdm K, of repeated pulmonary embolism. Ms S, who bled in her brain. All these, were unexpected events. And I don’t think I could ever forget them.
The neurosurgeons arrived, coolly assessed her, ordered some medication and went to speak to her sister, in tears outside. “Thank you, doctor,” she said to me, while I wondered, had I insisted on delaying her going to the bathroom and doing her investigations first, would she have survived better? The scenario replays in my head, over and over.
We get told off by seniors on a daily basis. Why wasn’t this done fast enough. Did you think of this. Go back and document that. Every day, the voices in my head are so loud: Are you competent enough. Are you fast enough. Are you astute enough. We need to be thorough, and yet fast- there is a quota we need to fulfill. Yet, we need to practice safe medicine.
Nothing in medical school prepares you for the reality of work, other than working itself. Every day, something could potentially go wrong. Yet, there is no other choice but to move bravely forward, gritting our teeth and leaning on the fact that God, not us, is fully in charge of life and death. And I only pray each day, that we do more good than harm, and play a bigger role in strengthening and not weakening, those chains in our delivery of medical care.
I panic, at times. When the intravenous plug doesn’t go in. When something unexpected happens. When time is ticking past. At the end of every shift, I feel battered. But I am glad, to look back to God at the end of each day and realize, He has put me, us here for a reason. There is something to learn from every situation, something to be gained that will make us better, faster, more astute. I am learning, that it takes prayer, to turn each traumatizing experience into something that builds and not destroys us, that it takes courage to face a senior who has shouted at you before, whose toes you have accidentally treaded upon (the air is often tense), that it takes perseverance to realize it is two hours past your shift and you are still waiting for some results to return. The learning curve is steep.
And perhaps, it comforts us to know, that God of the universe, is also God of my skills, my capabilities and my shortcomings, and He is also God of life and death. It takes a conscious letting go, to realize we are human, and there are limitations to our service to mankind. When NOW is needed, when NOW demands all of me, right now, can I also realize, that God, NOW, is in my situation and watching over me, over us? Do I realize that all that I have been through in the past, was God’s way of preparing me for now? And do I trust Him to know that all that happened then is sufficient for what now demands of me.
So I pray, before each shift, that God be who I serve, that I may serve joyfully, competently, and wholeheartedly. Because only then, can I serve without fear or anxiety or disappointment. We need His grace, day by day.
“But now, this is what God says…
“Do not fear, for I have redeemed you;
I have summoned you by name; you are mine.
When you pass through the waters,
I will be with you;
and when you pass through the rivers,
they will not sweep over you.
When you walk through the fire,
you will not be burned…
Do not be afraid, for I am with you…”
– Isaiah 43