Death on Easter

I was on call yesterday...wasn't too busy...intubated a patient outside ICU, which turned out to be a difficult intubation...that uncle wasn't even Chinese..i'm beginning to think that perhaps the scoline the nurse gave wasn't really scoline...though the uncle didn't fight when i was intubating him..except that his vocal cords were darn anterior and they were apposing each other...which shouldn't be the case if he was truly paralysed..anyway, two attempts and both times the ETT went into the oesophagus... but he didn't desaturate that bad..coz still could manual bag him..tried with bougie..couldn't get the bougie in...thank God a ex-colleague came to the ward (he used to be in GA but now in surgery)...so i asked him for help and he got the tube in...only then could i sigh with relief...and no, this wasn't the death on easter..

So then it was quiet till about dinner time...got a call from the medical MO on call...said they intubated a patient in casualty for low saturation...so needed an ICU bed...had to transfer an uncle out to the chronic ward though i'd rather not...coz this uncle had 2 near death experiences in the chronic ward and you know what they say about twice..there bound to be a third time (and i actually dreamt that that was what exactly happened to him during the fitful sleep i had last night)...

Anyway, that patient from casualty..let's call him uncle V..he was younger than the uncle i sent out.. though he had history of probably lymphoma 10 years ago...apparently completed chemotherapy and was in remission...uncle V lives in Canada and came back to Malaysia yearly for holidays.. how unfortunate that this time he developed fever and some difficulty in breathing...so he was brought to casualty and the MO there noted that his oxygen saturation was only 70% on high flow mask..so they decided to intubate him...

By the time they sent uncle V up to ICU, his ETT was already dislodged...the escorting houseman and nurse oblivious to his predicament...uncle V was also on double inotropes (albeit low dose), which probably explained why his blood pressure was only 60/30mmHg when we checked...i'm not even going to start raving about that...so i just told my nurse that we needed to reintubate uncle V...i prayed so hard that it won't be a difficult intubation..uncle V was Chinese though he was cachexic..and his cancer was supposed to have been at the neck region...thank God i got the tube in the first time...so we proceeded to resuscitate uncle V...put him on high dose IV dopamine and noradrenaline...set a central venous line for the inotropes..put in an arterial line to monitor beat to beat blood pressure...uncle V's ABG was horrible.. his paO2 on FiO2 100% was only about 55...i tried high PEEP and pressure control...was able to achieve good tidal volume but his oxygen saturation just refused to improve...

And he also had SVT..probably due to the high dose dopamine...rate was over 160 bpm.. BP was only 100/60 plus...so i tried cardioverting him twice..heart rate only came down to 150bpm..not much improvement in the BP also...he gradually deteriorated despite the inotropes, antibiotics and fluid challenge...he was having neutropenic sepsis, probably due to some immunosuppressive medications he was taking...by 5am on Easter his heart stopped..we CPRed him for 5 mins..his heart was revived but we knew it was probably the adrenaline effect...we called uncle V's brother and sister-in-law..by the time they came, we were starting a 2nd round of CPR...his relatives were Christians and so they were praying for his resurrection throughout the CPR...

Yet, i only felt sad knowing that uncle V would not be revived and that our effort was futile...by 6am, uncle V was pronounced dead...we CPRed for 30 mins and he never came back...he died a single man...my only consolation was that he is save with Jesus now....

I went to church after i bathed in the hospital..for the record, yesterday was the most amount of times i bathed during a call..twice...anyway, today's service was a talk show session...Pastor John was asked by the MC about how to break bad news to patients who were dying or terminally ill...so Pastor John was saying that there are many reactions he gets from patients when they get the bad news...the usual anger, denial etc etc.. he gave an example of a man who said," i was a hotshot businessman yesterday and today i'm dying of cancer...why me? why so unfair?"...and i thought to myself, what's so unfair about that? is it fairer if that man was a penniless nobody? because we're all sinners, we all deserved to die anyway...there's nothing unfair about dying...the only unfairness in dying was when Jesus, who was without sins, died on the cross to pay for our sins....

They also played a short video clip called 'the bridge'...it's about a railway bridgemaster and his only son...one day, while he lifted up the bridge, there was a train heading for the bridge..his son saw the train and tried to warn his father and the train...but the son fell under the bridge and the bridgemaster had to decide whether to let a whole train load of ppl die, or let his son die...i guess we all know what happened in the end...but all i could think of were the ppl in the train...they didn't even know they were going to die..and they didn't even know the sacrifice the bridgemaster made for them...

I know i sound like a fatalist...today is the day Jesus rose from the dead...he has conquered death once for all...we no longer need to fear death...but i can't help wishing that i didn't have to see my patient die today, of all days...anyway, Happy and Blessed Easter...tomorrow i'm on call again...