- But those who hope in the Lord will
renew their strength.
They will soar on wings like eagles;
they will run and not grow weary,
they will walk and not be faint.
Isaiah 40 : 31
People assumed that I had a wealthy and glamorous life. It is easy to think that. There are psychological traumas that I and others experienced that will never be forgotten. These will be with me until the very end. There are many I could write about. The list is long. However, the particular twenty-four hour period was the worst. It does not sit in the back of my mind. It is with me daily and will be forever.
This day happened in the mid 1990s, over twenty-five years ago. I was on call with the trauma team. There were endless staff shortages so I had transferred to the general intensive care unit and emergency theatre. My fate was sealed.
I was in the emergency theatre. The case had finished. I took the patient to the intensive care unit. There was a commotion around the bed close to the nurses station. The sister waved at me inciting me get there now. My primary duty was to the patient I returned from theatre. She was safe.
Along I went to the bed at the end of the unit. There was a girl in that bed, aged seven. She had a heart abnormality that had resulted in an aberrant rhythm.
She had been put to sleep and was on a life support machine. The group around her were trying to put a wire into her heart to correct the rhythm. They were not succeeding. I was asked to “have a go”. Ridiculous expression considering the ongoing events. I had not even washed when the lass developed an immediately life threatening heart rhythm. We tried for nearly a hour to revive her. The effort proved futile. I was left to explain events to the parents.
She had died.
What I could not understand to this day is why she was bought to the institution I was working at? One of the best known Children’s Hospital in the country was one mile away. Why didn’t they get one of their guys to come over and help? It all remains a riddle to me to this day.
To live in hearts we leave behind is not to die.
I was still trying to assimilate the horror of the case above when I received an urgent call from the accident and emergency department. There lay another young girl. She had been the victim of a “hit and run”, attempted murder in my view. She was unconscious with a serious head injury. I acquired help from the trauma team. We quickly prepared her for the head scanner. I stayed in the scan room with the girl. There, from my position I could that there some very bad news coming my way. The girl’s brain had been so badly damaged that she was brain dead. Her heart was beating slowly. Eventually it stopped. The only breathing was from the life support machine. Once that was switched off, there was nothing. My consultant had been told but never attended. The trauma unit consultant was there. The trauma consultants were always on site when on duty.
The trauma consultant spoke the girl’s parents.
At the blueness of the skies
and in warmth of the summer,
we remember them.
Sylvan Kamens & Rabbi Jack Reimer
Regarding children my nightmare had not ended. I attended a baby in accident and emergency. The tiny mite was found by his parents not breathing. The father had driven mother and child to the hospital. We were on standby because the mother had phoned ahead. We tried and tried. We were unable to revive the child. He was the victim of cot death syndrome.
I spoke to the parents.
Do you know that a man is not
dead while a man’s name is still spoken.?
A very elderly lady had presented to the emergency department. I was fast bleeped to the department. The attending doctor obviously thought he was George Clooney from the television series E.R. He boasted an American accent and was spitting out details as if he was being filmed. He told me that the woman had been bought to the hospital in severe heart failure. He gave her a dose of a white medicine we use in anaesthesia and intensive care. He had spent a short time with us in theatres. The doctor gave the lady the medicine so he could put a tube into her windpipe. Only one problem, the dose he had given was such that we would have given to healthy young males. Her heart had stopped beating. They were trying to resuscitate her. The woman was dead. There was no point in trying to revive her with that dose on board. I told him so and left. As I did so, he threatened to report me to the hospital authorities. I did not even bother to around to offer a retort.
The lady might have died anyway given her age and pre-existing problems. The doctor certainly contributed to her death.
All the art of living
in a fine mingling of letting go and holding on.
A lady in her thirties had been severely assaulted by her partner. Her ten year old son had phoned for an ambulance. She had arrived in the emergency room with a knife embedded above her left eye. It must be recognised that most people are right handed so knife injuries are usually inflicted to the left side of the body. She had been placed on a trolley in resuscitation bay. Basic monitoring had been applied. There curtains were drawn around her bed space. There was no member of staff by her side. Her blouse was soaked with blood. The doctors were busy contacting the scan room and the brain surgeon on duty. It seemed a logical approach.
In trauma there is a process called the primary survey. The purpose of this survey is identify and treat any life threatening injuries. It involves ensuring that all vital functions are stable. This takes seconds for an experienced trauma doctor. The last is very important. The patient is stripped of all clothing and all the body is checked for other possible life threatening injuries. The primary survey is a gold standard international protocol.
In this case there was no primary survey.
This young lady’s heart stopped. The emergency bleeps started shouting. When I arrived in the resuscitation room, the emergency department had not called the trauma team. I insisted they did. They arrived promptly. I pointed to the heart. It was clear that she had been stabbed in the chest too, probably the heart. What happens in this situation is that the heart is squeezed by leaking blood. There comes a point when the heart stops and there is no blood flow to the brain. There are about three minutes to restore blood flow to the brain. After which time brain damage begins to occur. The longer there is no blood flow to the brain, the longer it gets no oxygen. That causes the brain damage
The trauma surgeon wasted no time opening her chest. That helped restore some blood flow to the rest of the body. The hole in the heart was plugged. He then applied internal heart massage. That is squeezing the heart inside the chest to improve blood flow.
The young lady was taken to theatre. The heart surgeon arrived and stitched the hole.
The woman was taken to the trauma ICU via the scan room. Her brain had been severely damaged. This can be observed by the widespread swelling of the organ. When the time was right, brain tests were done to determine whether there were any functions of life remaining. There were not. The life support machine was switched off. Her son, parents and other close family members were at her side when she passed.
The following Saturday, I was call for the trauma unit. There was a ring at the door. The little boy arrived with his grandfather to thank the staff for caring after his mother. The grandfather told the staff that it was the boy’s wish to do this. He came across to me with his arms outstretched wanting a hug, I reciprocated, he whispered in my ear, “Thank you for looking after my mum”. I quietly replied, “It was my job to do exactly that” The boy did not shed one tear. They left. I made myself a big mug of coffee. I went outside. Sat on a kerb to reflect. There were certainly tears rolling my cheeks.
The bureaucrats had been trying to shut that particular trauma unit down. It was a world
re-known institution. Other centres in many places had used that trauma unit as a role model. The emergency doctors, wanted to take control of all admissions including trauma. They felt they had the skills to manage all incoming patients. Clearly they did not. Meanwhile the bureaucrats were too busy trying to save money whilst picking up wallet bulging salaries. Life mattered less to them than money and medical politics. Eventually they had to give way and restore the trauma unit to it’s rightful position. Once more the unit is admired by many across many lands.
From a personal perspective, I think I learned more working there as a trainee than I did anywhere else. The position at times bought great sadness but the training was the best.
God gave us a memory
so that we might have roses in December.
A man had been in a bar. He had just left when he was assaulted by two thugs. The assault included kicking the man in the face, head and stamping on his head. There were markings elsewhere too. The head was the immediate priority.
This time the trauma team and I had been alerted. We were on standby when the patient arrived. The man’s head was the size of a football. It was obvious that he had severe head injuries. The emergency doctors called for a brain surgeon to attend. Meanwhile we transferred the guy to the scan room. Due to a lack of oxygen to the brain, his brain had been severely damaged.
The man died. He was a father, a husband, a son and a brother. He was killed by two yobs for very trivial reasons.
Walk on, walk on with hope in your heart
and you’ll never walk alone.
Rodgers and Hammerstein
From the musical Carousel
Teamwork is not how management describe it. In medicine it is about working together, learning from others and teaching people. It is about very good communication. If people are unable to communicate well, it is wise for them to either become pathologists or find an alternative career to medicine.
This post was not written to criticise other people. Nor was it written to boast bravado about anaesthetists or the trauma team. It was written because these are real events. It was the worst day of my career. I know not whether it is my personality or something else. The faces of many I can still recall. Sometimes I can see the faces of the families, especially when I told them bad news. It wasn’t unusual to switch off life support machines. However, it was always done after a thorough chat with the family. Occasionally, they wanted a certain relative to be present. If possible that time would be given them. Undoubtedly there were many more successes than failures. I recall some successes too. The failures I incessantly took personally even when I knew that there was nothing more I could have done.
At the end of that twenty-four hour I sat in the corridor outside the ICU twirling my hair. I had done this since I done this since childhood when I needed to think and clear my mind. I did the same whenever sitting exams. I would exit an exam room looking like a punk rocker. However, that morning I was also crying. After a short sojourn, I washed my face and returned to the unit. I considered my reaction to be human. I never to this day thought it was a flaw in my character.
When the ICU consultant arrived that morning. It was the same one from the day before. He knew fine what had happened during the previous twenty-four hours. The senior nurse had told him. He did not have it in him to ask how I was.
We completed the ward round and I left. On my way out the trauma consultant caught up with me. We had coffee and a chat privately in his office. The only other people that asked me how I was were the senior ICU nurses. I guess the younger nurses just didn’t know what to say.
Writing about days like these does not prove cathartic for me. I’ve tried before. The memories never escape me.
It was my job. I chose the practice. I knew there were upsides and downsides. I just never thought I would ever face a day like that. Who would?
Even though I walk through the valley of the shadow of death
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.
Psalm 23 : 4
English Standard Version
Sleeping with the Gasman
Thank you for reading this post.