An Arresting Moment

I watched someone die today.

The day starts pretty routinely: ward rounds, paper work, A&E. After seeing a few patients in the morning, the A&E waiting room is almost clear. Down the hall, a private GP in town is using one of the emergency beds to cardiovert one of his patients.

When private patients come in to the hospital with their GPs, they don't need the services from the public docs, and definitely not want to be bothered by pesky med students like me. So when the nurses tell us that such and such patient is private, we leave them to their treating GP. And this morning is no different. Everyone's focus is on the public patients in the waiting room.

Just when I pick up the chart of a patient waiting in one of the consult rooms, a nurse walks briskly through the door. She says urgently but calmly, "The private patient is having an arrest, we need more doctors." All of the docs on duty drop whatever they are doing and rush to the emergency bed. Immediately, I feel the adrenaline rushing through my body and follow everyone into the room. The patient is a morbidly obese middle-aged woman. She lies there motionlessly with a flatline on the ECG monitor. Immediately, the bed is surrounded by ten people. The GP quickly and expertly intubates her, one of the nurses takes over the oxygen bag, another nurse administers adrenaline according to doctor's order, another doctor rips off the ECG leads and starts CPR, yet another doc gets the defibrillator ready for the shock. Everyone seems very subdued and moves purposefully, completely different from what they show in medical dramas on TV. There's no screaming, no exaggerated movements, no trays getting knocked over. The room is strangely quiet, save for the humming of the electronic equipment, the sound of everyone's footsteps, and the faint sound of counting by the doc administering the CPR. After a minute of CPR, the doc in charge of the defibrillator tells everyone, again in a surprisingly subdued voice, to stand clear. He pushes the button, the patient jolts. CPR is resumed. James, the other med student at the hospital, is asked to do it. He jumps onto the stool and starts the chest compression. After another minute, another shock, with a higher voltage this time. CPR again, this time it's my turn. I get on the stool, put one hand over the other, lock my elbows, and start the brisk compression of the patient's chest. I look down. The patient's bloated face is blue, her eyes half open, staring lifelessly into space; her rotund abdomen reverberates with every push. "...Three, four, five..." I count as I go so the nurse on the oxygen bag can time the oxygen delivery. Another syringeful of adrenaline is pushed through her IV port. I keep pumping away, the only sound I hear is my own breathing, everything else fades into background noise. My arms and back start to ache. After about two minutes, someone taps on my shoulder; I stop and the docs check her vitals. "She's back in sinus rhythm," someone says. Slighly relieved, I step off the stool.

The syringe after syringe of adrenaline must have kicked in. Her heart starts to beat again. As she starts to wake up, she puts up a slight struggle against the tube in her throat. But it doesn't last long. Before the docs can sedate her, the adrenaline starts to wear off. The beautiful green rhythmic squiggle on the ECG monitor starts to distort like bad TV reception, then the single beep of a straight line goes across the screen, as if to pronounce the death sentence. We have another brief attempt, but it has already been thirty minute since her first cardiac arrest. The brain has been deprived of oxygen for too long. The GP calls the time of death. We breathe a collective sigh. Without a pause, everyone heads back and picks up from where they left off. The patient's GP goes out to the waiting room to deliver the news to her family. The lifeless patient lies there like a mound of flesh. A nurse brings a sheet to drape over her. I pause for just a second, thinking how this woman probably never expected to meet her end this way.

Then it's lunch time. A couple of the doctors and I head to the cafeteria. We chat about this and that. The conversation is light and casual, like that death this morning was just another patient passing through the hospital. In a way, that's true; deaths happen in hospitals all the time. We can't allow it to affect us too much or we will not be able to do our job. I'm sure that, in time, I will be desensitized to it. But I hope that I can learn to maintain an appropriate level of professional detachment without becoming a callous and unfeeling doctor.