However many doctors you may meet, some incidents are a rite of passage that almost none will forget.
The first day of college, the first dissection, the first delivery, the first surgery, the first post-mortem. Each of them has a variety of emotions and thoughts associated with them. Each person reacting differently.
But one event, that every single doctor remembers, is the first death they witnessed. It is a perverse memory, where a stranger’s death stays a part of you forever.
I first met death as an intern posted in the pediatrics – This was my first posting as an intern and I still was new to handling patients.
Much less, handling a sick 700-gram preterm baby. I was monitoring him through the night, with instructions to inform the PG residents in case of any complications. I had a senior nurse posted with me and I felt a little more secure. The nurse went for a bathroom break and suddenly I watched the baby’s saturation drop. 99%—-94 %—-90%—-87%—–70%—-I watched helplessly, not knowing what to do, whether to yell for the sister or to call my senior. I started basic resuscitation and the nurse returned. We initiated CPR while waiting for my seniors to arrive.
The next few minutes went by in a blur. I was supposed to give chest compressions to the tiny body. There was no improvement in vitals and my senior PG, who had seen this before, asked me to stop resuscitation. The baby was dead.
But I thought he was being cruel. And I continued chest compressions, hoping my force will bring this child back to life and crying for this child’s death. Not even alive fully, I thought of his parents’ sorrow. Until my junior PG, a good friend, intervened kindly, to tell me to compose myself.
That death is still one of the most vivid of my memories. Also, the composure my residents showed, was almost inhuman to my mind at the time. I could not believe that people could take death without being moved to tears.
A few years later, I was a second-year resident in general surgery, A 16-year-old boy, who had a blunt injury to his abdomen three days ago, arrived in shock. He was the only child of a poor, widowed mother, who was crying helplessly. In view of his hemodynamic status and history of blunt injury, we decided to post him for emergency laparotomy.
As we rushed him, I had an enthusiastic intern posted with us, running all the errands. The child arrested twice before surgery but was successfully resuscitated. We shifted him to the ICU and waited for the OT slot to open quickly.
By the time he reached the OT table, it had been about one hour from his entering the hospital. He had also arrested 13 times, only to be revived each time. I was personally hoping that this child would make one of those wonderful stories. We joked he would go the Guinness book of records if he did survive. My intern looked optimistic and was counseling the mother along with us.
We cut open his abdomen and found multiple perforations. It was a miracle he was alive this long, or that he could be resuscitated at all. Just as we were planning damage control, he arrested again twice. My intern who was also scrubbed in, also jumped into the CPR, while we all were in our scrubs. This sixteen-year-old had arrested 15 times, each arrest making hopes of survival and a full life, less and less likely.
We rushed to get him off the OT table and planned to revisit him, After 24 hours, hoping time and antibiotics would help, where we could not.
He arrested one final time, 16 times for each year of his life.
Each member of our team, the consultant, my senior PG, me, the anesthetist, the ICU staff had hoped and worked hard for a different outcome. Each of us was feeling the mother’s pain.
But we also had played with death earlier; where u lose, better to accept defeat gracefully. Better to joke with death than to hold on to its irreversible decisions. Better to focus on the hundred live patients rather than to dwell on this dead patient. Better to protect yourself and not think of the mother’s grief. Or each death will drive you mad.
We moved to the next patient while remarking how sad it was that this wonderful story did not come true, trying to bring humor to a very sad death. And I caught my intern, crying and remarking how thoughtless we all were, unmoved by the death of a sixteen-year-old, her allegations, reminding me of my own.
My mind flashed back to the day I had cried for that little body. I could not remember when I went from feeling that death as much as that of my family member, to a point where I could move on almost seamlessly when a death happened. Was I as inhumane and cruel as I thought my senior PG was? What is right, to feel the pain of each patient or to move on with a clear mind to the next patient?
Is the naïve desire to save every patient the right way or the cynical acceptance that you cannot win all battles the real answer?
I still don’t know the answers to this question.
My intern is now a PG resident, I guess facing her fair share of deaths.
Perhaps life does come full circle, ironically to death.