Sunday, 7 October 2012

He was here, and then he wasn't

Death, like birth, happens everyday. As a lowly med student, I can't say that I'm able to boast my experiences, but the mere amount of deaths I've seen so far could, at least, grant me the sight of Thestrals.

But what makes this one death so heartbreaking? The patient (let's call him J), age 18 years-old, very much compos mentis, was admitted to the hospital for recurrent episodes of cough and occasional dyspnea due to what he described as "a lot of mucus in the throat". He also admitted to experiencing 6 kg weight loss over the course of 1 month. He had been to another doctor who gave him a simple cough medication that didn't work too well. On the evening of his admission, J went into an episode of generalised tonic-clonic seizure that lasted for approximately 1 minute. On the next day he went into two more episodes separated only by 7 hours. A history of epilepsy or previous seizures was denied by both the patient and his father. An ENT consult was made, and a CT scan of the head was ordered for the next day.

J's second morning at the hospital went as usual. Med students went on rounds, got pimped and everything, and new lab results were reviewed. During the rounds J was as conscious as before, that is to say, even more conscious than some of us sleep-deprived derps med students. In short, that was an ordinary boring morning until a woman, a family member of another patient, called us loudly and pointed to J's bed. All of us jolted from our chairs and saw J was seizing again. And so we were relieved. Nothing happened. Well okay, a seizure was taking place, but we had expected something worse. We just stood by J's bed, one of us did the usual things for a seizing patient (protecting his head, etc.), and we all waited until he stopped seizing a few short seconds later.

But then the unusual took place. J did not respond to his father calling him. After the seizure stopped he turned flaccid and not... quite awake. My ER-trained instinct sent me immediately to the nearest BP cuff and torchlight. I palpated the radial pulse first. Nothing. Alright, BP then. This is wrong, I thought. I got no blood pressure reading at all. Maybe the equipment was faulty? Maybe my stethoscope isn't placed correctly? I repeated my reading but nothing, still. No detectable pulse and BP. I handed it over to a nurse but the result was the same. My friend reported absent carotid pulse and mydriatic pupils. Wait, what?! A nurse quickly set up an ECG reading. Ventricular tachycardia. A shockable rhythm, I know, but we don't have defibrillators, and our only instruction was to do manual CPR. But of course it was futile. In a few seconds, J was no more.

Can you imagine his father's shock? Can you imagine our shock? Can you imagine what heavy guilt the father must have felt, when the internist mentioned aspiration as the cause of death? Aspiration, due to the water he gave his son to drink, to relieve that pesky little cough.

It was so sudden. So unexpected. It was a sharp ache to the heart, so sharp that for a long moment everyone in the room---med students, nurses, other patients and their families---fell silent. For a long moment only a scream of agony over the loss of a son was heard. It was way too unreal and a part of myself honestly wanted to laugh it off and told the father that his son was coming back. That this was just a normal part of a seizure. That this was anything but death.

But death it was. It took a while to sink in, but it was there, as mighty as it has always been. Medical explanations sounded strange and far away. Like some fake tunes that try too hard to please. Like a pair of hands that tries to cup the entire water in the ocean. They answered the how, but never quite answered the why. Why, of all people in the world, did it have to be a handsome young man who hadn't even reached his 20's, with fresh dreams and aspirations, with a bright smile that had made us wonder what he was doing at this hospital in the first place.

So this makes me think:

You are only here for one moment and it lasts exactly one lifetime.


The day after, the bed sheet was new and it was identified with another patient's name.

1 comment:

  1. As I gaze at the mound of unsettled earth
    I long to dig a second trench
    And face the night
    Beside him

    To lie silently as the light of the moon
    Floods me with its ghostly gleam
    Falling on my weary face
    Reflecting in my eyes

    To carve my hands in the black walls
    Bring down the earth upon me
    A shared blanket against
    The cold

    To feel the burden of heavy damp soil
    Crumbling down as I struggle
    Through a endless myriad
    Of forgotten dreams

    To turn and whisper softly to him
    He needn’t fear the darkness
    While I shudder myself
    To sleep

    I yearn to lay my shovel aside, set down my loneliness
    To lay in the earth and bury myself
    And face the night
    Beside him.


Any thoughts...?