Thursday, August 16, 2012

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Two deaths

I WOKE UP to the news of my patients' deaths. Both expired early in the morning and were never revived successfully.

The first patient, a 30-something obese man, came to the Emergency Department three days ago with fixed dilated pupils. He was unresponsive even to pain stimulation and had high-grade fever. His neck was rigid. My superiors were entertaining a brain infection in its advanced stages. Unfortunately, because of the acuteness of his condition, I didn't see much of him.

The second patient, Mang Ronny, 65 years old, was close to me. I had been his student-in-charge since day one of my Neurology rotation. Because he had been confined for almost a month already, his chart was thick when it was first endorsed to me, packed with indecipherable notes from various services, laboratory results, antibiotic schedules, and nurses' narratives. I was overwhelmed when I wrote my incoming notes. It was the longest clinical abstract I had written.

I would visit him hourly when it was my turn to do the ward monitoring. He was diagnosed with stroke; one of the blood vessels in his brain was obstructed. After taking his blood pressure and pulse, I would ask how he was, and he would answer as best as he could, despite the oxygen mask perennially attached to his face. When he was intubated and could therefore not speak, he would still do his best to raise his arms, as if to say, "Here, Lance, take my BP now."

His wife always stood beside him. Never mind the fact that she was slow in complying with the doctors' orders (often to the patient's detriment), that she had to be reminded to pay for the labs requested days before, submit the X-ray requests to Radiology, or buy better antibiotics immediately. She was always gentle and hopeful, looking with curious eyes after I removed my stethoscope from his husband's arm, and asking, "Okay lang ba siya, Dok?"

Mang Ronny's antibiotics finally looked like they were working. His blood counts improved; his lung function was better. The resident was looking forward to discharging him in a few days until early this morning, when my blockmate saw him deteriorate in a matter of minutes. Fixed dilated pupils was a bad sign. Eventually, a code was called. He was resuscitated and was still unresponsive. The time of death was pronounced at around 5:30 am.

I dreaded the thought of coming to Ward 5 this morning, seeing both their names erased from the patient list, let alone visiting two empty beds. I wasn't able to say my condolences to my first patient's family, but I saw Mang Ronny's wife and son along the hallway, their faces tired from crying, bundles of bed sheets and pillow cases on one side.

"Nakakalungkot po ang nangyari. My condolences po. Ipagpepray ko po na sana ang Diyos ang maging lakas ninyo sa mga oras na ito," I told his wife.

She started crying. She said things happened too fast, that she didn't expect Mang Ronny to die so soon. After verbalizing her thoughts to help her make sense of things—because isn't it true that acute grief removes all sense from the world?— she said thank you. "Salamat sa pag-alaga sa kanya. Salamat nang marami."

I went back to the call room, updated Mang Ronny's clinical abstract, filled out the details, and looked at the flat line in the ECG tracing taken just before they pronounced that he had died. In my favorite corner in the call room, I was wrestling with the sadness I felt, praying that God would help my patients' families cope with grief, keeping my tears from flowing lest others would see them.


Identifying details were modified to protect the patients' privacy.

2 comments:

  1. Lance, was he the patient I passed on to you? :( Sir Herb told me what happened..I got so sad.. :(

    ReplyDelete

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