Sunday, July 5, 2009

I cried

N.B.: Thalassaemia major is a genetic blood disorder that's very common in Sabah. The haemoglobin levels become very low due to increased red blood cell destruction, necessitating repeated blood transfusions for life prolongation. It's incurable and non-communicable. Thalassaemics don't live long. In the end, their hearts invariably fail.

He collapsed.

The doctor and nurses pumped in all sorts of drugs into his veins and did a cardiopulmonary resuscitation (CPR) to save him. His ECG reading was bizarre. Ventricular fibrillation ? An endotracheal intubation was done as he was unable to breathe spontaneously.

It's an emergency.

I could hear the hysterical cries of his mother as SL and I took turns to do the chest compressions.

He suffered from beta-thalassaemia major and had developed severe decompensated heart failure and acute pulmonary oedema. A few thalassaemic patients, whom he'd got acquainted to while being hospitalized, looked from afar, stunned and helpless. I guess the situation must have freaked them out, knowing that that's how their lives were going to end.

The doctor managed to stabilize him. But, I knew deep in my heart that his prognosis was bad. The nurses left him to fill up some forms. I guess there're some routine blood investigations to be done. I volunteered to do the bag ventilation for him as there's no mechanical ventilator in the ward.

Everyone left. I suspected the doctor had relinquished all hope in reviving him. I did the bagging patiently for the next 45 minutes. Who knows there might be a miracle? This sounds ridiculous, but it's an idealism all medical students are supposed to have.

I took a hard look at his almost lifeless body. His nasal bridge was depressed. His cheekbones and forehead were prominent and his liver was huge, all of which were due to extra-medullary haemopoiesis characteristic of the disease. Iron deposition secondary to repeated blood transfusions had put on a slate-grey coat upon his skin. He opened his eyes wide to stare at me thrice. A reflex that ached my heart.

Uncontrollably, tears welled up in my eyes. I didn't see that coming, seriously. I hastily dabbed my tears and pretended to wipe away the perspiration on my forehead when a staff nurse suddenly barged in.

He died in the A&E department half an hour later.

Miracles rarely happen.

15 comments:

  1. May the patient rest in peace... and you have done the best you can... hugz.

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  2. So you killed him eh? Worry not, more to come

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  3. You have a good heart. Good to know that. But don't get too emotional when come to work, all the best.

    *hugs*

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  4. Hey, you tried your best. He clung on as best he could.

    ...why is it common in Sabah?

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  5. u had done ur very best dude...its normal to feel sad when we bum into thing like this..but dont get to emotionally during working ok..its not good..

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  6. Bagging for 45 minutes? No one I know would bag that long without taking turns. I give you all my respect for your patience and compassion. You'll be a great doctor someday.

    p/s: Hardly any thalassaemia in the hospital wards here. A perennial exam favourite!

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  7. pikey,i wasnt the hero. i just did the bagging

    rcks,i didnt

    lm,i will.

    freedom,nah...i m not emotional. haha.am always on the look for cute nurses rather than shedding tears.

    hafiz,thanks.

    little dove!! hey u r here!! tot u'd disappeared. i did it all alone coz my fcuking groupmate who was with me left. apparently because she thought it's not requirement in the log book n hence a waste of time.

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  8. AIYER! Reply to everyone but me! Hmph!

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  9. its not a good idea to cry in front of patient's family if they are around. cos tat would make them more sad and u too might become too emotionally attached to be able to concentrate on your next patient

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  10. bunny,opps. i overlooked ur comment. ahaks. i don't know why. geographical distribution,perhaps.

    bluesole,hey i didn't really cry out loud lar. just a few drops of tears. nobody noticed!! haha.

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  11. Miracles happen in ways that we least expect. And there's no such thing as false hope.

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  12. i had a thalassaemia ptt today too. but he was admitted to internal meds after arriving at casualty.

    take k be strong joey :)

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  13. as the years goes by your heart will harden and the tears will not be able to drop anymore but good to know you have compassion in ya!

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  14. surprised to see ur comment, but thanks, drew. i guess i will get used to it. =)

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