“Doctor, there is a patient..”

the nurse softly knocks my door at 1 am, 3.30 am , 5 am and so forth. People come walking, wheeled or wheezing into the small Emergency room of the hospital at all small hours of day and night. My devil moans “Why do they ALWAYS come at this time of the night?” and almost immediately the gentle angel, with the white wings and all that, softly coos “It is no fault of theirs that they are sick. It is your privilege to be tending to the healing process in a fellow human”. The complaints range from ‘runny nose for 2 days, came to just make sure’ to ‘not responding at all’. Sometimes, the devil rages on inside (NEVER, my dear fellow human being, let its voice be heard outside) about the casual attitude of the patient and bystander, and wants to hammer some sense of propriety into them but the angel comes with a stupid but valid comeback “Why judge? Treat and part ways, so both sides can be happy”. After the initial assessment, the patient is wheeled into Intensive Care or back home; my work starts or ceases for the time being, respectively.

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That, my friends, was the real, reflexive me, working on a spinal basis. Some thinking is involved in the decision making process but, dear reader, be good and don’t harp on the nitty-gritties. Most clinical work is experience, pattern recognition, good luck, Gods’ grace and a random combination of the above-mentioned things. Now moving on to the philosophical, thinking me.

Studio Ghibli (Photo credit: Wikipedia)

Any of you seen any Studio Ghibli movies ever?

If you haven’t seen,please do see a few (My recommendations- Only yesterday, From up on Poppy Hill, My neighbors the Yamadas). Its ok if you haven’t seen them, just go with the flow. These movies are pure 90 minutes of anime magic that will definitely scratch away a few layers of yourself and expose the romantic/child in you to the pure bliss you’ll be feeling at the end.

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“Doctor, there is a patient.” Reality jolts me back to the emergency room. Time – 00.05 hours. Date – yesterday, technically today morning. A young man with severe back pain and vomiting comes in walking. Along come his worried brother and anxious wife. He sits down on the bed. I go and check him. Pulse ok, breathing ok and abdomen ok on examination. A strong smell of alcohol pervades the air round him, just like the mild delirium he is in. I think, “Ah yes, the common garden variety alcoholic tummy ache. Two shots- one for the nausea and one for the acid burning up his oesophagus, will send him home just fine.” I ruminate on the fracture I had missed on X ray of an 8-year-old girl, just an hour ago. I was lucky that the senior orthopedic doctor was available in the hospital late night to set right the child’s bone, my ignorance and fractured ego.

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I drift back into the reverie of being a child and replay the scenes from the movie in my head. I wonder about the rich imagery and painting like feel of the scenes, wondering how much effort would have gone into each of the scenes. In case you are wondering, Studio Ghibli still makes animation the old fashioned  (hand drawn) way. And there is a lot to observe and absorb from the scenes when I look with my photographic eye as well. The different planes, the diffusing focus, the lines and colors are enough to send a photographic connoisseur to ecstasy. I ponder upon the majestic talents of all the people in the studio…

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It was the wife who cried out first. My patient let out a deep moan, sort of like the gasp of a man in the throes of dying. He must be aspirating some of his food and drink from last night, I think and sit in my chair. He lets out another gasp and I slowly make my way to him, thinking, “I have seen this, I can control this. Worst comes to worst, what can go wrong? Death-the inevitable champion, right”. (I think the sooner you get sensitized to death in your medical life, the better. But boy, was I wrong tonight.) He lets out another series of gasps and lies unresponsive, just like a fish out of water, spent after its struggle. His wife is wailing now. Suddenly, the gravity of the situation takes me up and gives me a slam-dunk.

Emergency (Photo credit: Tax Credits)

Along with my reflexes, medical instinct and skills, the demons of every doctor- doubt, fear of self-deprecation, come freewheeling down my gullet. I shout orders to shift the patient into Intensive Care and reflexively pull him from his bed onto the trolley. Pandemonium on a small scale begins to erupt around my head. I pull him as fast as my worried self and semi – guilty conscience could , into the Intensive Care. The first sound to hit me were the monitors of the other patients, their persistent beeps hammering the truth into my head that life somewhere around is going fine and sleeping. Everyday I curse the monitors for their insistent beeps – akin to an inconsolable colicky baby- but now those noises seemed to tell me, ” Yes, life goes on. Put in your best shot and hook me up. I will show you the truth. ” Once the door closed behind, the familiar smell of the Unit, the blessed beeps and most importantly, the cool air from the air conditioning, bring some fragments of sense into the space surrounding my head.

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The colors are wild, even beyond imagination. “Become earth, that you may grow flowers of many colors.”- says Rumi, the poet. They capture your attention for a fleeting moment but then rivet it in concrete in your mind. 

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Prompt cardiopulmonary resuscitative efforts came in, a few months training and the reflexes kicking in. Once the monitor was up, the sine waves from his heart appeared as graceful as a ballerina’s pirouette. (Torsades de pointes or the “twisting of points”, for the medically inclined.) There he was, lying without a palpable pulse, with his heart dancing away to a persuasive but fatal rhythm. There was no time to be lost. After a few moments of fiddling with the demons of doubt and fear, the paradigm of ‘wrong decision’ against ‘ no decision’ came to mind. Without hesitation, ‘ wrong decision at the right time’ won and I reached for the defibrillator paddles. (Let me add, half a minute of ‘phone-a-friend’, helped enormously.) Delivered 2 jolts of pure electrical energy of 200 Joules to his heart, 2 minutes apart, furiously giving resuscitative efforts and medications in the hiatus. A senior anesthetist came in the meantime, restoring some sanity and calming down my own heart’s flutter. He put a tube into the patient’s lungs to help him breath during this time of crisis. Slowly but surely, the fatal rhythmic beauty of his heart reverted back to boring, regular waves of a sober heart.

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The colors stay on, despite the movement of the scenes and ending of the movie.

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True story.

 

PS. My apologies if you haven’t understood the medical terms quite well. Long story short, a young man came in with a fatal heart condition brought about by a heart attack. I was able to bring the fatal rhythm under control and then referred the patient to a higher center with people and facilities better equipped for further care.

I will not be able to forgive this incident or my lassitude in the beginning that prevented me from making a proper decision when it was most appropriate. However, I thank God and all my teachers who prepared me for such a situation, allowing me to get back on the near-miss incident and do the best I could to help my patient.

As an afterthought, “only things one never regrets are one’s mistakes. – Oscar Wilde”. Right?