(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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