-I kept the ultrasound. Someone I never met.-
It was a usual morning in the neurology ward I studied at, beginning with patient’s morning assessment and completed with morning report. Suddenly we hear a man shouting outside the room, he was rambling and I couldn’t hear clearly what he said but it was full of negativity. There were thirteen of us inside the room, having a daily report of each patient’s condition with a neurologist. Shortly after, a friend of mine from other department opened the door and in a panic tone said, “ISO1 is having an apnea.” Apnea is a medical term for patient who couldn’t breath spontaneously, it is an emergency condition which could be fatal to the brain and life if not treated adequately. Nearly all of us looked in shocked, although this is not the first time we are in such situation. But this time it is different to me, because it is my patient. The same patient I had in my last post.
I rushed outside and went to the isolation room, the same room I was at just two hours ago for my routine assessment. Six doctors were inside the room already, two people doing electrocardiogram (ECG), one trying to install an ETT tube to ensure patent airway for the patient to breath, one squeezing a bottle of NaCL 0.9% to give fluid and prevent hypovolemic shock, one injecting an epinephrine, and one person doing cardiopulmonary resuscitation. I was assessing the patient ECG and blood pressure, then replace my friend in doing CPR. I did 15 cycle before we transferred the patient together to the ICU room while ventilating the patient.
Doing CPR for 2-3 minutes to the patient let me observe and be aware of what happening during the emergency phase. While counting the rate and depth of the CPR, I could saw her eyes opened not symmetrically and unresponsive. We were concerned about the patient, but we were more concerned about the baby inside her. She was treated 5 days before going into semi-coma state, but because of her pregnancy doctors couldn’t do procedures she should has if she hadn’t been pregnant. We have to wait for MRI from other hospital and couldn’t use CT-scan to detect cerebral edema in her head. Many drugs couldn’t be administered either. It was a hard case even for senior doctors.
In two weeks of routine care, I have become familiar with her husband who’s waiting for her in the hospital. They were both still young in their twenty’s, and they were waiting for their second child to be born. We met at least three times everyday for assessment, discussing the prognoses and next step of care with neurologist, but there was nothing much we could do. In the next two days after being administered to ICU she needs two other CPR, she was still alive but in the morning when we were about count the baby’s heart rate, we couldn’t find any. IUFD, intra-uterine fetal death, that’s the medical term for it. Her husband were told about the condition and he has accept it, a spark of happiness he had just a month ago was now gone. It wasn’t easy to watch senior doctor talking to the patient’s family for such loss.
When I was on a night shift last Tuesday, her family ask to chant an approaching death prayer for her outside the time permitted. Of course we allow it, that was the least thing we could do other than comforting the family. Sunday morning she passed away, her heart rates keep on going down and unresponsive to any drugs. But we all know it will happen sooner or later, her family knew it as well. There’s nothing much doctors could do but to treat her symptoms. Two lives enter the hospital, none goes out. So if we, doctors couldn’t cure patient, what do we do? Perhaps this was the meaning of a saying from the father of medicine:
“Cure sometimes, treat often, comfort always.” – Hippocrates dp
A lot of times, doctor and science couldn’t help to save life. But we do try our best to alleviate pain and give a proper way to death.