When Three Hearts Stop

Last Friday morning I woke up at 5.30am wishing that I could be transported off to another life – one where the alarm didnt ring off at such an unsociable hour and one in which I didnt have to stretch my already worn out brain for another 12 hour shift. I had after-all just completed my first week of medical on-call shifts. This meant that as well as working on the stroke ward from 7.30am until 6.30pm I had to then continue on until 10pm running around the hospital dealing from everything from a drug chart needing to be re-written, to a patient who had become haemodynamically unstable i.e. they were about to become another mortality statistic for the hospital. I was flat out knacked that Friday morning as a result, and all I wished for was a quiet simple, no frills day – with maybe some free chocolates from a patient’s family for being such a lovely doctor. Well, we can live in hope.

How very unprepared I was for the Friday that lay ahead.

It started off fine – I dragged myself onto the early morning train, avoided eye-contact with the new crazy guy that now seems to frequent my carriage daily, dressed in a black string vest and wearing what can only be described as a face that says “I want to kill”. I got into work, grabbed a coffee, and printed out some blood request forms in the doctors mess (the common room), before wandering down to the stroke ward.

That, ladies and gentlemen, was the beginning of the end of my quiet Friday life that I had politely requested.

All hell broke loose.

My cheeks had barely compressed into the seat at the ward desk, as I was reading through a new patient’s notes, before a nurse sprinted out of the bay opposite me – “she’s not breathing!!”. The mind works in funny ways – as I felt myself saying rather sarcastically “ok – Well, let’s press the cardiac arrest bell, shall we?!”. Suddently everything was in motion – my junior doctor colleague also on the ward obligingly jumped on the patient’s chest and began chest compressions, I ran to get the crash trolley – wheeling it down the ward, driving it like I stole it, before slapping on the shock pads onto the patient’s chest around the ongoing chest compressions, and nurses expertly set about getting oxygen mask, intravenous access and bloods on the patient. Suddenly the 5 of us there became 10 as the on-call medical team turned up to expertly help lead the arrest. This, all before 8am. Everyone was caught off guard but we had managed to get to work incredibly quickly – for which I was immensely proud. We worked on this lady for 45 minutes but sadly owing to her long list of health problems the prognosis was always going to be poor and she did indeed die.abg

[An example of an arterial blood gas (ABG) result we use to assess a patient’s metabolic status e.g. in a cardiac arrest – note though this ABG result is not from a patient who went into cardiac arrest]

Now the day was really out of sorts as I had to talk to a very clearly upset family and manage the next steps in their late mothers care (I say ‘care’ as I believe we have a responsibility still after death to be respectful, transfer the body, and help make what is an unimaginable pain – at least a smooth process).

“Nick – I think you need to see this patient”…a nurse politely says to me in an effort to soften the blow of handing me another patient about to die. You cannot be serious – I thought to myself in true John McenRoe style. Indeed, a second patient, within an hour of the first dying was about to die. This time though, the story is written a little differently for this is a lady who was for supportive care only. What does that mean? Well, quite simply it means that we do not actively treat an illness for we as medical professionals along with their family, have decided that it is in her best interests to just support her symptoms and that cure is futile and would only prolong pain, suffering and distress. Nobody wants those. I went to see her and for the second time in less than an hour and a half, had to certify a death.

Sod the coffee, I need a whiskey now.

But, life is not going to allow me thoughts of a whisky just yet, for I have an entire ward round of patients to see (admittedly two less than before) and I am already hours behind time. Getting home for 6pm is looking like that hopeful lottery win. Optomistic at best.

So the day continues, all without a single break, as each patient perfectly throws up problem after problem, and my brain, body and spirit slowly becomes crushed that little bit more as the afternoon ticks by. As I come to the last patient on the ward round around 5pm I do what my old intensive care consultant calls the “end of the bed-o-gram” and I look at this patient. I look at her for a good 30 seconds, remembering how she looked yesterday.

This lady, who is not for resuscitation (just like the previous lady and for similar reasons), is clearly dying right now. And within 10 minutes she was dead. Very peaceful, pain free, comfortable, and not alone. I completed my third death certificate of the day. I was in disbelief – this has never happened to me before – draining didnt even begin to describe it. I had to look over my shoulder to check that Death himself wasnt following me! I checked a mirror – at least I had a reflection – I was still alive.

So the clock ticks round to 6.15pm. The ward round is done, nobody else has died, and my senior house officer is back and helping me tidy up lose ends. But the day wasn’t quite ready to release me yet. For simultaneously TWO brand spanking new patients are wheeled in by the London Ambulance Service Team onto my ward…

“You got two repatriations from Charing Cross Hospital, boss. Where do you want them?”

I wanted to say anywhere but THIS ward, but of course I just smiled, crying inside that sort of deep sobbing cry that only babies do, and directed them to their beds. Now if you are wondering what the big deal is – having two brand new patients that is – let me explain: Each new patient requires the following:

1. A full clinical history taken

2. A full head to two examination of every single system – cardiovascular, respiratory, musculoskeletal, genito-urinary, gastro-intestinal and neurological – the latter of which takes over 30 minutes alone!

3. A cannula inserted and a full set of bloods taken

4. A chest e-xay

5. An ECG

6. A full clerking proforma completed

7. Telephone handover to the night team

And I had two to do, on a Friday night, after a week of hell, when all I wanted to do was a) have my lunch (now a  very warm chicken wrap) and b) go home. I sobbed internally once more.

…..8.45pm.

That is when I finally left – a full 3 hours and 45 minutes after my working day, according to the wonderfully effective ([cough]) European Working Time Directive told me I should have gone home, I left work…and had my lunch. I had nothing left to give.

…Now I am of course writing this on a Sunday evening having spent a wonderul weekend back home with my mum and dad, seeing my unofficial godchildren and my best friend. I stilll feel tired from last week but I am mentally refreshed and a little more reflective than I may have been on Friday night – mainly because I can actually think now. My week, and particularly my Friday all sounded rather dramatic, tiring, and challenging – and to a degree yes they were. But as I sit here, with the news on in the backrground hearing stories of soliders being blown up in combat, civilians fleeing oppression, families loosing their children to dog attacks, I feel very very grounded again. And thankful.

My day was hard, yes, but people experience days, weeks and years that are infinantly harder and painful.

It was just a day after-all.

On that note, find something to be thankful for and enjoy every single day.

See you next week,

Dr Nick

Advertisements

3 thoughts on “When Three Hearts Stop

  1. I guess it puts bad days generally into perspective. So often in my line of work ( training & development) when we work with very stressed individuals people say ‘ well at least no one is dying’ – guess you can’t use that one!!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s