“It is the secret of the world that all things subsist and do not die, but retire a little from sight and afterwards return again.” – Ralph Waldo Emerson
There are those moments in medicine that really give you pause. Moments that make you stop, reflect, and really think. For me, that “moment” lasted one hour, fifty-seven minutes.
We were on our morning ward rounds and it was business as usual – asking the patient how they’re doing, checking their vitals and adjusting their management plan accordingly. On this particular day, one of our patients suddenly became unresponsive.
In our classes, our instructors tell us to try to stimulate the patient to determine if they’re actually unresponsive – shout their name, shake their shoulders, rub their chest. If they’re unresponsive, the next step is to check their pulse.
This patient didn’t have a pulse – she was in cardiac arrest. We had to start CPR – Cardiopulmonary Resuscitation. For CPR, you start off with 30 compressions in the middle of the chest; well, ‘the lower half of the sternum’ to be exact. When a person goes into cardiac arrest, it means that their heart has stopped beating – it’s stopped pumping blood to the rest of the body. Chest compressions do the heart’s job for it, to keep blood pumping around the body.
This wasn’t the first time I’ve seen a patient crash – where there was nothing more we could do to revive the patient and it wasn’t my first experience with CPR. But this was the time that really left an indelible impression on me. I think it was because this time I was there while her family members were coming to the bedside to say their goodbyes.
It’s impossible, I think, to be in that place and not think about your own loved ones. It’s impossible to avoid reflecting on whether you’ve spent enough time showing the people you love that you love them while you still have them in your life.
I think by now we’re more or less aware that things don’t go actually down like we see on Grey’s Anatomy, but it’s still striking how different things are in real life. For one, there was no one yelling “Charge!” while holding “paddles” aloft waiting to jolt the patient back to life. Of the four heart rhythms you’re likely to see in a patient in cardiac arrest, only two of them are responsive to electric shock. For the other two rhythmic, like in this patient, you have to continue with CPR- cycles of 30 chest compressions to two breaths.
It was an experience like I said, I won’t soon forget, but sadly, it’s one that I’m sure I’ll be experiencing many times over in the future. I know that death is an inevitable stage in life but there is yet a finality to it that forces one into deep introspection.
For all the exciting moments in medicine where you crack a difficult diagnosis or treat a patient successfully, there are also these moments where you have to come to grips with the fact that there is nothing more you can do. It’s a powerless feeling.
Today I left the hospital much wearier than usual. It feels like one of those nights where I need a long shower to wash away the day.
And I remember Martin Carter’s immortal words: “Now from the mourning vanguard moving on/ dear Comrade I salute you and I say/ Death will not find us that we die.”
And though I know it was written in a different context, it yet comforted me.
