Her last words were ,"Ooh, that's just lovely". She sighed contentedly at the warm blankets placed on her shivering body.
Shortly after, she went into cardiac arrest.
The buzzer was alarmed and a flurry of people came rushing in, each filling a role that needed to be done in this critical situation. I stood at the edge of the bed and forced oxygen into her lungs periodically with a bag and mask. Chest compressions were underway to the chorus of "1, 2, 3, 4.... 30." In between mandatory breaths, I was fixated on suctioning her secretions and inserting a Guedel's adjunct for her airway protection.
At some point into the routine we had adopted in our efforts of resuscitating her, her family was led in. I remember clearly the tears that poured down their red cheeks and the sound of the wail that was released, the absolute fear and horror embedded in that one cry.
Focused on the task of ventilating this elderly woman, I lost track of everything else. Time flew by as we ran through cycle after cycle of CPR. It was only when I looked up and noticed that no one was compressing her chest anymore that I realised what my boss had said.
"This is an irreversible cause for an asystolic arrest - we'll call time of death here."
...
These past few months as an emergency registrar have been extremely rewarding, and when asked about my job, I would often say that this was what I was meant to do, I truly do love it.
However, for many reasons, it has also been extremely tough.
Good long cleansing cries after work are not an uncommon thing.
Firstly because there are haunting situations such as these - where the sudden loss of a good person is felt so deeply and the immense grief of close ones reverberate through to us staff members too. Apart from this patient's family members tonight, I have the image of an elderly man sitting by his wife's bedside in absolute fear that tonight would be the night he lost his wife of over fifty years. She had suffered a catastrophic bleed in her brain. I also carry with me the memory of the son of another patient who had been so strong through the extensive family meetings for his dying father today. In the presence of his tearful mother and sister, he remained calm, comforting and collected. I later encountered him on my way out from work - he stood in a quiet corridor crying alone.
And then there is the overwhelming politics of emergency medicine as well, having to juggle the advice of different specialty teams and health professionals and ultimately make the final decision for the patient based on what we felt was best for them. Inpatient doctors aren't always happy with how things work out but, I'm starting to learn that you can only do your best in this job and even then, you can't please everyone.
It's been a steep learning curve too, and I have learnt so much this year. Often, I learn by being thrown into the deep end of having to manage a condition I have never managed before. My seniors have been supportive, but inevitably, mistakes are made at times. The outcomes of those mistakes can be painful despite the lack of significant clinical consequences- be it the yells that come from other treating specialists or the yells from angry patient families or the immense guilt that comes anyways.
On top of that, our ED seems to attract a lot of very violent people who are drug affected. The loud echo of profanities towards staff members is not an uncommon background noise, and if I'm honest, it does get quite tiring when we are in that situation too often.
Lastly, I've found in my time this year as well, that emergency training is probably one of the least respected training options amongst medical doctors. Oh the kind of criticism I have sat through from doctors of other specialties, even those closest to me, about how terrible and hopeless ED is. I hear annoyed remarks regarding the lack of faith they have in us. It becomes very demoralising and disheartening, especially when I know that I've worked to my fullest capability to try and do right by the patient with the resources that I have.
...
A while back, I was led to this article directed at young ED doctors written by a famous emergency physician - https://lifeinthefastlane.com/a-letter-to-a-young-emergency-doctor/ . After another difficult shift a few weeks back, I re-read the article and felt this resonate with me.
"Your ED colleagues get it. No-one else does. Others can imagine, they can listen, they can sympathise, but they don’t get it. Don’t expect them to.
When you feel a failure, when you think you have let someone down, when you think you’re no good and never will be, balance it up. Think of someone you helped, something you did well, a person whose life you touched even briefly and left better off than before they met you. If you’re doing this job right, there are far more of those."
My bosses kindly remind us - "You always tend to remember the one 'bad' thing you did, but not the hundred other good things you've done for people. Remember those."
I close my eyes and think of the other patients I have worked with who have gotten better, or who have been helped in some way.
I think of the patients we couldn't save today, but at the very least could offer a dignified, comfortable death. I think of how I was privileged to comfort family members in their greatest time of sorrow as they battled with the reality that we have truly come to the end of the road.
I close my eyes and remember the good days, the happy stories - and accept the.. wholesomeness of this burden I have chosen to carry upon myself.
...
I'm thankful though, for how Papa has so faithfully carried me through.
As I sat in my car today after another overwhelming night, I was put to peace once more by the soft tune and encouraging words of "Glorious Ruins" playing in the background.
"Where my courage ends, let my heart find strength in Your presence."
Today I rest, and I debrief.
And tomorrow, by God's grace, a new day begins, with a new set of challenges, joys and work to be done.
