It was supposed to be a free weekend; one that I'd been aching for since weeks. You never expect a post double-emergency weekend to be free for a Trauma Registrar..... but, yeah, I did manage that feat in the middle of the week, thanks to people not drink-driving, falling, stabbing, hanging precariously outside locals, etc. etc. on Sunday or Monday (surprising!!!).
Anyways, today I got a call from my colleague in the wee hours of the morning that one of my patients in the Trauma ward had expired. To the best of my knowledge, I had no patient admitted under my care in the ward. So this statement raised a few eyebrows! On further probing, she was the trauma patient who I had shifted to the General ward around 2 months ago after stabilisation and had to be shifted back in view of poor general condition. Despite our best resuscitative efforts, the patient could not be revived and was declared dead.
I remember the situation around 3 months ago when this patient presented to our casualty as a case of Road Traffic Accident (RTA) with head injury. She was referred from a private hospital, intubated and on AMBU support. She definitely required a ventilator. I was the Trauma Registrar on call that day. We had no free ventilator in our Trauma Ward and I was forced to refuse the patient and asked them to take her to another public hospital where they most likely would have a ventilator available. The husband begged me to admit the patient. In such cases, we take an AMBU consent from the patient's relatives stating that they are willing to perform AMBU ventilation on their patient till the time a ventilator frees up (yes, considering it's a public hospital and with our limited resources and high volume of patients, we have to!!!). The husband appeared desperate. Apparently he had spent lakhs of rupees on her treatment in a private hospital and had run out of money and could see no results in his patient. Hence, the referral to a public hospital (a very common scenario at our hospital and hence the portrayed high "mortality-rate" despite the optimum care given).
This patient was under my care in the trauma ward for almost a month. I will not go into details of how she was resuscitated, stabilized and shifted to the ward after almost a month of being on a ventilator, being tracheostomised and then being weaned off the ventilator, undergoing a PEG (feeding procedure) etc. etc. All I can say is that I put in my best efforts to save this patient!
Shifting her to the ward after stabilisation was one of my biggest personal achievements given her co-morbid conditions as well (morbid obesity, Diabetes Mellitus, borderline hypothyroid).
To hear of her death got me thinking for a while.....
Back to this morning.......... After I heard the news, I cut the call, pondered for a while wondering what could have gone wrong and went back to sleep. Yes, that was my reaction. And, this similar non-sympathetic behaviour HAS become my reaction to the death of any of my patients! Am I heartless??? Think not.....
Death is an irreversible cessation of life- that state of the body that shows complete loss of sensibility and the ability to move..... the complete cessation of the functions of the brain, the heart and the lungs, the so-called "tripod of life" which maintain life and health. Death is a part of life and a part of my JOB. That is an unwanted reality that we as doctors have to face on a regular basis (especially in a trauma set-up). Initially, I'd be quite taken aback and found myself being emotionally involved. as a student in my MBBS days. After graduation, when I was authorised to declare death, I really couldn't bring myself to shed a few tears over someone else's loss, even if I wanted to. I gradually began to realise how and why this happened and why it mattered. As a doctor, I cannot let death take an emotional toll on my life. Yes, you may call me stone-hearted, heartless or whatever. But, I guess this is in the best interest of all the future patients that I will be treating. If I had to shed tears over every death that I have witnessed and had I let each of them shake me up emotionally, I would have given up being a doctor long ago! All I'd be thinking of were dead people! I wouldn't be able to work, to eat, to drink, to sleep..... just imagine!
Yes, I'm heartless during such situations and I have to be. I can empathise with the relatives but that's that....... I CANNOT let my emotions overcome me. And that is what my profession teaches me.......
There have been a lot many occasions like these, where I have given my all to save a patient, to see them eventually die. Frustrated, check.....Angry, check......Sad, check...... Unhappy, check. And a whole gamut of emotions- check, check and check again! Do I portray those emotions......NO! Can't get myself to either. It just dies down till I witness another death!
I can just imagine what you must be thinking but unless you're a doctor, I don't really expect you to understand.
So far, in my short surgical career (many years to go.....still), working in one of the best Trauma centres in our country, I feel as if I've seen it all. Victims of railway accidents with dismembered limbs, some carrying their own leg in their hands (YES!!!), electrocution injuries, stab victims, gun shot victims, burns with trauma, road traffic accidents with their wide gamut of presentations, month old babies falling off God-knows-what-not. (image alongside says it all, I guess. A concrete slab impacted into this young boy's skull with damage to the underlying brain matter successfully extirpated by our neurosurgery team. He was discharged, with just a scar at this site!). Lots more to see, I guess....
All I know is that those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body.
That's some food for thought, I guess. . . . . .
Anyways, today I got a call from my colleague in the wee hours of the morning that one of my patients in the Trauma ward had expired. To the best of my knowledge, I had no patient admitted under my care in the ward. So this statement raised a few eyebrows! On further probing, she was the trauma patient who I had shifted to the General ward around 2 months ago after stabilisation and had to be shifted back in view of poor general condition. Despite our best resuscitative efforts, the patient could not be revived and was declared dead.
This patient was under my care in the trauma ward for almost a month. I will not go into details of how she was resuscitated, stabilized and shifted to the ward after almost a month of being on a ventilator, being tracheostomised and then being weaned off the ventilator, undergoing a PEG (feeding procedure) etc. etc. All I can say is that I put in my best efforts to save this patient!
Shifting her to the ward after stabilisation was one of my biggest personal achievements given her co-morbid conditions as well (morbid obesity, Diabetes Mellitus, borderline hypothyroid).
To hear of her death got me thinking for a while.....
Death is an irreversible cessation of life- that state of the body that shows complete loss of sensibility and the ability to move..... the complete cessation of the functions of the brain, the heart and the lungs, the so-called "tripod of life" which maintain life and health. Death is a part of life and a part of my JOB. That is an unwanted reality that we as doctors have to face on a regular basis (especially in a trauma set-up). Initially, I'd be quite taken aback and found myself being emotionally involved. as a student in my MBBS days. After graduation, when I was authorised to declare death, I really couldn't bring myself to shed a few tears over someone else's loss, even if I wanted to. I gradually began to realise how and why this happened and why it mattered. As a doctor, I cannot let death take an emotional toll on my life. Yes, you may call me stone-hearted, heartless or whatever. But, I guess this is in the best interest of all the future patients that I will be treating. If I had to shed tears over every death that I have witnessed and had I let each of them shake me up emotionally, I would have given up being a doctor long ago! All I'd be thinking of were dead people! I wouldn't be able to work, to eat, to drink, to sleep..... just imagine!
Yes, I'm heartless during such situations and I have to be. I can empathise with the relatives but that's that....... I CANNOT let my emotions overcome me. And that is what my profession teaches me.......
There have been a lot many occasions like these, where I have given my all to save a patient, to see them eventually die. Frustrated, check.....Angry, check......Sad, check...... Unhappy, check. And a whole gamut of emotions- check, check and check again! Do I portray those emotions......NO! Can't get myself to either. It just dies down till I witness another death! I can just imagine what you must be thinking but unless you're a doctor, I don't really expect you to understand.
So far, in my short surgical career (many years to go.....still), working in one of the best Trauma centres in our country, I feel as if I've seen it all. Victims of railway accidents with dismembered limbs, some carrying their own leg in their hands (YES!!!), electrocution injuries, stab victims, gun shot victims, burns with trauma, road traffic accidents with their wide gamut of presentations, month old babies falling off God-knows-what-not. (image alongside says it all, I guess. A concrete slab impacted into this young boy's skull with damage to the underlying brain matter successfully extirpated by our neurosurgery team. He was discharged, with just a scar at this site!). Lots more to see, I guess....
All I know is that those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that this moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body.
That's some food for thought, I guess. . . . . .
good one..you are right,if we portray empathy towards each dying patient..we might land up in depression.
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