| Sunday, September 27, 2009 |
| The power to kill |
He was a 'transfer-in' from the intensive care unit. He was placed in my cubicle, to be looked after by me.
I didn't like what I saw when they brought him in. He was scrawny, didn't smell right, had a tracheostomy that was so poorly maintained I could hear the amount of phlegm in it everytime he breaths. He had 'tuberculosis' and 'alcohol' written all over him. When I had finally gone through his notes, I'd learnt that he was a known case of tuberculosis admitted a month ago with severe chest infection requiring intubation and was supported by a machine for a long time, then developed a pneumothorax, then had another lung infection again. To make things short, he had one messed-up pair of lungs. Plus, I saw the words 'poor social support'.
Great, not only I have to look after this guy for a long time, I have to keep contacting the social welfare department to find a way to support him so that he can leave the hospital.
It's hard enough to take care of someone with a long-standing disease. It's harder when you're stuck with someone who is so uncooperative you'd want to yell at him everytime he refuses to eat. Then comes the part when your specialists and medical officers take one look at him and you can tell that they've given up on him ever leaving this hospital alive. Rounds will take less than a minute, all orders are 'continue the same' and finally, I'm stuck with the load of making sure his trachoestomy hygiene is maintained, his feeding is supervised, his arterial blood gases are satisfactory, and my patience and temper are in check.
Then that day came. The nurses told me he was gasping. His oxygen saturation was so low. We pulled the screen, prepared for resuscitation, but something inside of me told me, "Let him go." And there I was, 90% sure that that was the decision that I was going to make. "Let him go. If you intubate him now, he's only going to suffer more." 5 minutes later the rehabilitation team came, and the medical officer saw what was going on and I'd let her take over since she was more senior to me. They'd intubated him and he was back on the life-support machine. I could see in his eyes when he became more conscious, "Why is that tube back in my mouth?!" He didn't look happy about coming back to life.
My specialist and medical officers weren't too happy about him being back on the ventilator either.
"Should have just let him go."
"His lungs are so badly damaged. He'll never be off that ventilator now."
"Even if he walks out of this hospital, his quality of life will be horrible. Who is going to look after him?"
I was more angry with myself than with what was happening around me. I didn't become a doctor to make decisions on whether a person should be allowed to live on. I would usually leave those decisions to the family members. I've never felt so cold in my spirit as I did when I saw this man gasping for life. Days went by and I did my rounds as usual, reviewing this patient. Everyday I'd wonder, "I'm glad the rehab team came and took over, but would he be better off otherwise? Why did God intervene and brought the rehab team? Does this guy have a chance at walking out of this hospital, and living his life, despite what most doctors think?"
Yesterday, I'd learnt the truth. My colleague told me that my patient was unresponsive. By time I saw him, he was gone. We did the usual resuscitation but we all knew that he was gone. I now know that it wasn't God that told me to let that patient go a few days ago. God brought the rehab team, not to save him, but to save me. This time when my patient died, he left at God's decision, not by another human being's.
May his soul rest in peace. Thank you Lord, for saving my soul as well. |
posted by Sha @ 12:36 AM  |
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| 3 Comments: |
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ooo... i know how u feel... sometime... it's difficult to make such decision.. we know we can't actively make that decision but we just have to do whatever we can at the mean time isn't it... God have plans for him :) May him rest in peace...
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Yup this sounds like what every doc goes through. Let me tell you what happened to me once.
Post-call on a Saturday, boss came to do rounds late at 12pm. As he was nearly finished at 2pm, the 2nd-last patient to be reviewed (a TB patient) decided to collapse in front of us. We did active resus... and was confident his time was up.
However at the 19th minute of CPR he came back to life. I had to bag him for an hour while the MO pleads with anaes for either ICU admission or a ventilator.
We had to bag him another half-hour while the ventilator was brought to our ward. I went home at 330pm pissed... at every juncture, the thing that makan more masa happened. I really cursed in my breath "why didn't he just die?" at every turn.
Wasn't my proudest moment. :P
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hye there, dropping by to say that your posts are very inspiring. ^^
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ooo... i know how u feel... sometime... it's difficult to make such decision.. we know we can't actively make that decision but we just have to do whatever we can at the mean time isn't it... God have plans for him :) May him rest in peace...