We went to the ward as usual, at 7.30pm, for our on-call session. After a brief survey of the ward and the surroundings (since we just had a change to this ward, we're quite new there), we begin to cover the cases. There was only one new admission. We clerked a little, and looked at the progress of the patients in their respective patient folders.
Then, I heard the house officer phoned someone, saying something about the oxygen saturation of a patient falling. After that, two other doctors came (I presume one of them was the one who received the call), and following a brief assessment of the aforementioned patient, they were soon starting to provide respiratory support for the patient. We went over and we saw a patient who seemed to be unconscious. He was so thin, his bones and ribs could be seen quite clearly, with deep depressions in between. There was prominent muscle wasting.
The staff available, the doctors and nurses were moving fast, to get the equipments and all; while some patients and their family members were trying to peep behind the curtain. It dawned on me then that it was really an emergency (yea, I know, I was quite naive; this was my first experience). Soon, another doctor from the ICU came, and they began to start intubating the patient. They attempted a few times, first with a normal set of intubation equipments, and then another 'set for difficult intubation' (that's what I saw written on the box). After a few unsuccessful tries, one of the doctor was able to obtain a laryngoscope attached to a monitor (something like a scope to visualize the tract), and they were able to insert the tube successfully. With the intubation in place, the valve bag was used to pump air into the now 'breathing' chest.
But there was another problem: the heart rate was falling. They administered IV adrenaline (lots of times, I think) but the heart rate was not recovering. So, the doctors attempted CPR. Before long, the four of us, medical students, were alternating to do CPR. The wife was at the bedside, reciting prayers. She went out for awhile to answer some calls, but when she came back, I noticed her eyes and nose to be red.
Amidst all the CPR and ventilation via the ETT tube, the heart rate was not recovering. On the screen of the cardiac monitoring machine, without CPR, the heart rate was just a scribbling line. The doctor suspected pneumothorax, and inserted a chest tube (the first time I've seen such a procedure, in front of my own eyes). There was bloody fluid oozing out into the tube (I'm also not sure what it was). All the time, we just kept doing chest compression and pumping air, but there didn't seem to be improvement. The patient's chest already looked and felt to be rather soft, from all the compression. I myself was sweating all over my forehead. It really took quite some energy to perform the compressions, and what's more, I didn't have my dinner. How long we have been keeping up like that, I wasn't aware. Perhaps a little more than half an hour, or an hour maybe. But finally, the doctors decided the patient could not be saved, and we abandoned our resuscitation efforts. Sure enough, once we stopped, the heart tracings on the screen fell to the dreaded, straight, horizontal line. One of the doctor shone a pen torch at the patient's eyes but I didn't manage to see what he was looking at. I guess he was just checking the pupillary reflex, which I suppose was absent. Just some moments ago, I saw the patient's legs twitch when the doctor was trying to insert the intubation tube, but now, he was lying motionless. Still, despite all the commotion. There was neither chest nor abdominal wall movement.
We left. The patient's wife was already weeping. After that, their relatives came, and we could hear their cries from behind the curtains. The doctors went to discuss the case and did some documentation, while the nurses carried on to complete the remaining tasks. As for us, we just stood aside, digesting for awhile what just happened. A relative of another unrelated patient actually asked me if the patient we were trying to save were dead. I dismissed her question and just looked away. I didn't know how to respond. It certainly was a new experience for us. It would have been good if the patient could be saved. I admit, this thought did come to me a few times, but alas, we were just humans.
It was late. There were more relatives surrounding the patient's bed now. They were sombre and grieving. There was nothing else we could do. We went back.
Looking back at it, how did I feel? My friend, one of the four of us there, asked me. I wasn't able to answer her back then. Honestly, I didn't know what I felt. I just thought it was a pity the patient could not be saved. Kinda reminds us why we wanna be a doctor, doesn't it? I just hope I am able to be a good doctor, someday.
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