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Life and Death

Posted Oct 04 2009 11:14pm
Today I realised how thin is the line between life and death.

It was late afternoon.My appointments in outpatient department in my hospital was running late by more than an hour[as usual]. The coffee I ordered to keep me awake was unduly late in coming.
In walked an elderly, thin and ill looking gentleman.The chart showed me he was 74. He was accompanied by an innocent looking girl. The girl did the talking.She said her grand father is feeling tired and is having no appetite for the last few days. He is also not sleeping much.She attributed it to him taking care of his ailing wife who is admitted in a state of coma in the same hospital with a massive stroke few days ago.
He was pale, eyes sunken, all skin and bones.I asked him what was troubling him. He was hard of hearing.So I raised my voice and asked again.He said he had no appetite nor he is able to sleep.He told me about is wife.He said the wife is showing some improvement and there is still hope that she will become conscious one day.

I examined him quickly still thinking why the coffee is not on my table yet.His pulse was little weak,blood pressure and heart sounds ok.They have already done some blood tests. It showed he is anemic and also having mildly elevated blood sugar.

I thought everything is due to anemia. So I raised my voice to tell him about his sugar free, green leafy vegetable rich diet.He asked me whether he can take rice both at lunch time and at dinner.I said yes,but he did not hear it.He suddenly slumped in his chair,his face becoming more pale and his hands rigid.His breath was just a gasp.I called him loud and tried to feel his now absent pulse.The grand daughter was screaming with fright and asked what was wrong.
I with help of the nurse carried that frail man on to the examination couch.He was taking gasping breath but no heart sounds.I started cardiac resuscitation by rhythmically thumping his chest with the proximal part of my palms.I asked the nurse to take the young girl out and to bring help immediately in form of a stretcher to take the patient to the ICU.The nurse went to telephone to dial but I yelled at her to run to the emergency department for help.

For me it seemed it took a long time for the orderlies to come with the stretcher but actually they came in 3 minutes.I was continuing my cardiac resuscitation till I reached the ICU.
In the ICU the nurses put an IV line and stuck the electrodes of the cardiac monitor on his chest.I looked at the monitor.There was no activity.It was asystole or Cardiac standstill,a form of cardiac arrest which is difficult to reverse. I shouted orders one by one. A male nurse was continuing the Chest thump and I could hear a rib creak.I called out to be careful. By that time breathing had almost stopped.I called out for an endo tracheal tube to be put into the wind pipe. A nurse handed me the laryngoscope and another the endo tracheal tube.I could put in the tube with the help of the scope properly with in seconds.Now his breathing is taken care of as the nurse started pumping oxygen into his lungs with the ambu bag.

The male nurse was still continuing the cardiac resuscitation on the chest.I called out for more iv drugs to be given.
'Defib' I shouted.
The machine to give electric shock to the heart to try to make it come alive was ready.
'360 joules', I ordered and put the pads on that thin chest, asked everybody to stay away and pressed the button.The patient jerked and the smell of burned skin came into my nose. 'Give me more jelly on the pad', I shouted.
I looked at the monitor.It showed a flurry of activity as the cardiac resuscitation continued.It raised my hopes.I ordered more drugs to be pushed IV. But slowly the line in the monitor became flat.
'Defib' once more I shouted.This time a nurse did that as I watched the patient jerking again receiving the shock. This time there was not much activity in the monitor screen. The electric shock was repeated again and again, the jerking of the lifeless body continued and the monitor showed the flat line of death.


I looked at my watch. It was 30 minutes ago that this man asked me if he can eat rice both at lunch and dinner time.But it seemed a long long time ago.. And meanwhile he had passed the line between life and death.

Now I had a few live patients to see and I was already so late. I asked my junior, the resident medical officer to do the paper work and the rest of the formalities.

When I reached the OP, the coffee was there on my table, already cold.By then I was fully awake and so I ignored the coffee. As the next patient came to sit on the chair that was just now vacated by the life of that old man, I realised how thin is the line between life and death.
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