His last whisper (translated)

(Translated from the original piece written in Bahasa Sug: Hinapusan hagas, published Sept. 8, 2013)

Bismillah.

It was one of those days as an LU4 student when we had our bedside preceptorials in Philippine General Hospital (PGH) as part of our class activity when this happened. My group was assigned in the Pedia wards and was assigned to a patient with a lung disease to check and try to learn how to properly identify and diagnose a probable disease. We also had a preceptor, a Pediatrician who will guide us along the course of the preceptorials.

Upon entering the wards, one simlpy cannot help but feel saddened by the state of the patients in PGH, especially if they are kids. You will see different patients with different ailments: some have enlarged heads, some had bandages on their tiny arms, some were inside these tiny incubator boxes, some had tubes in their mouth, and some are even too young to be there (just some weeks or months old! Poor thing! (-_-).

We arrived at our patient’s bed and were introduced by our preceptor to his mother. The preceptor then started discussing things, the basics and approach to a pediatric patient. Some of us started talking with the mother to get pertinent history of the patient’s disease. while another set of students were already playing with the one-year old child to get the child’s attention and liking. But me being the inattentive one, was actually observing another patient back then.

Of all the patients in that ward, I can’t help but notice this patient lying on a bed not far from us. A boy of about 10 years of age. Just looking at him and you can fairly conclude that he is really sick and already toxic. He had this yellowish skin (jaundice), enlarged abdomen and sunken eyes. A number of IV fluids were hanging beside his bed and he had a nasal canula placed on him connected to an oxygen tank nearby. He appeared really weak and lethargic, he can even barely open his eyes that well. But he was awake back then, as he was being fed by an older male companion (perhaps his father?), giving him some spoonful of porridge. An older, weary-looking woman was sitting beside him, caressing his arms, keeping him warm. By the way she look at him, I could fairly conclude that this one is his mother.

And then I observed him trying to talk to her mom, as if wanting to say something to her. And as if getting that cue, she stood up and came closer to him. I saw her leaned and placed her ears close to the kid’s lips. He was whispering something. Maybe he was thirsty, or he needs to go to the toilet, I assumed.

I stopped observing them when a classmate came to me and asked what was I doing not listening to our preceptor. My group-mates were already taking turns listening to our patient’s chest and observe any abnormal findings. Our preceptor started asking questions on the theoretical matters of our past lectures and so I tried listening to her now, lest she might call me and I can’t say anything.

And then suddenly the ward was in commotion.

We heard a woman shouting somewhere not far from us, crying: “Kaya mo yan! Wag kang susuko anak! Kayanin mo!” (“You can do it! Don’t give up, my child! Fight!”). A nurse came running from her station and went to check on that bed, the woman still crying was now being restrained by an adult man, maybe her companion. Our preceptor stopped from her discussions, our patient’s mother held her son and checked what was happening. We, to, were already looking at the place where the commotion started. At first, the nurse who just came in—now busy maneuvering things on the bed--was covering the face of the patient she was trying to help, so I can’t recognize it yet. It took me some time before I realized what was happening. The woman I saw earlier trying to listen to that child whisper was the same woman now wailing and crying at the floor, shouting: “Kaya mo yan! Wag mo kami iwan!” (“You can still fight! Don’t leave us!”). And the patient being saved by the nurse is the same patient I was observing earlier!
A few seconds more and a doctor came rushing in from their callroom. He checked the patient’s status and without even a shade of hesitation, he shouted:

“CODE!”

I felt Goosebumps crawling all over my skin. Everything was set in slow-motion like you see in the movies. Everything BUT them! The doctors come running, some checking the patient’s pulse, some adjusting the bed, the nurses getting equipment from their station, running with all the syringes and fluids I can’t even recognize. A young female doctor climbed up the bed and started the chest compression (resuscitation). One! Two! Three! I was unconsciously counting her chest compresses on the patient. One doctor was already shouting “Ambu-bag please! We need Ambubag here!” Some personnel came running with the ambubag, then another bringing some kind of curtains to cover the bed and prevent other people from seeing what’s happening, especially in that place where the patients are all children below 19. But the curtain only covered half of the scene, only those towards the other patients were blocked. The other side was towards us, and we were seeing all of it happening right before our eyes.

One! Two! Three! Four! Five! The doctors keep doing the chest compression while another doctor bags air to the child. "Rhythm check! No pulses! Continue compressions!" They have already taken turns doing this, for three times already. Still, nothing’s happening. Compress. Breathe. Compress. Breathe. A classmate went to the crying woman to comfort her, while the doctors try to do whatever they can to save the child.

Most of the students like me who were there were all stunned. We were all piled in a corner, observing all these things happened; speechless, helpless. I remembered what was taught to us during our lectures on Basic Life Support (BLS): the brain can only sustain an oxygen-less environment for 5 minutes. Anything more than that is deleterious. That is why resuscitating the patient the soonest possible to save the brain is the goal of this procedure. I heard someone say that a usual ACLS will end at the 20th minute if the immediate family would consent to stopping it.  About  15 minutes already passed, and still, nothing. I was able to glance at that child and for a moment I saw his right hand moved. But maybe I was just being deceived by my own hopelessness. Some trickle of blood was already flowing from the sides of his mouth as the resuscitation was still going on.

"One! Two! Three! Four! Breath! Rhythm check! Still no pulse! Continue! Epi given!"
They keep on pressing, still not losing hope. I kept on counting each press.

One! Two! Three! Four! Five! –Thirty! Air! One more try! One! Two! Three! Four!

It took us some more minutes before the doctors finally stopped and declared the time of death at 9:51am. Slowly, they all returned to their stations, some with their heads bowed, exhausted and defeated. The nurses and the remaining personnel started packing up things in silence as the woman who cried earlier wept more, clinging to the last remains of that child who shared his last moments, his last whisper to her.

Inna lillahi wa inna ilayhi raaji’uwn. (Verily from Allah we came from and to Him we shall all return).

This is the first time that I was able to witness a real “Code Blue” in a hospital setting. A situation against time to save someone’s life. IT WAS SCARY! It sent shivers all over my spine! You will certainly feel the heavy burden of this job that we are now trying to attain. To save a life was never an easy job, and to lose one is a bigger burden you will carry all your life.

I glanced at my classmates and saw them, just like me, in shock. It was our first encounter. A real-life, eye-opening experience… and we are expected to meet much more cases in our future career here in this hospital, when start doing our "duties". When we will be the ones to compress and bag, and call the "code". I can't... I still can't imagine myself yet doing it, but I know if that time comes, we needed to be prepared.

We were all having that same dream of “saving a life” and somehow helping other people. But that single incident shook us all to reality. That we, as future doctors, cannot always win over death. That even if the brightest, the smartest, and most skillful of all physicians would come together and save a life that was bound to end, we can still do nothing about it. That we, doctors and future doctors alike, are still humans after all. We are not God. We have no power over this thing we call “life” and “death”. It is all in the hands of the Creator, He who gave us life, and He who shall take them away from us eventually.

“Kullu nafsin Zaaikatul mawt”… “Every single being will certainly experience death” Allah said in the Qur’an (Surah AL-anbiya: 35). There’s no arguing with that.

We went home that day in silence, with that heavy feeling of unexplained sadness. But perhaps that single experience made us more determined too, to become better doctors. To learn more and be the best we can that we may become more useful to our patients in the days to come, in shaa Allah!

Wa billahil tawfik wal hidaya,
Salam Kasilasa

-Ahmad

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