death in the ward

two weeks ago, i had a patient who died on me. this was not the first time that a patient i knew died. what made this different was that i actually saw it happening in front of my own eyes.

i was about to leave the ward with the rest after a massive round of ass jacking from our orthopedic lecturer when we noticed the emergency. so some of us thought of staying back and skipped lunch to see and gain experience on managing an emergency case.

the poor guy was involved in a road traffic accident. according to friends in the A&E, he was vomitting out blood there. the doctor thought they had stabilized him so they shifted him off to the ward. that decision probably caused him his life.

once in the ward he was coughing out massive amount of blood. when the doctors inserted a tube into his lungs, blood came gushing out. within a minute or two, there was more than a liter of blood in the container. they had to clamped the tube to control the blood lost while they arranged for a blood transfussion. in the mean time, the patient became restless and started to struggle. so they had to restrained his arms while me and a few others held on to his legs. blood was just pouring out from everywhere. his lungs, his ears, his iv line and his pants were soiled with urine. he probably was bleeding into his abdomen as well cause from visual inspection, it was grossly distended. CT scan revealed a skull fracture.

in other words he was a goner no matter what.

as the doctors tried valiantly to resuscitate him, he suddenly just stopped moving and went blank. his eyes were opened and was starring blankly into space. then his heart stopped and his PO2 stats started dropping. one of the doctors started doing cpr while the rest continued to resuscitate him. the blood lost was so massive and quick that the doctors had to manually transfused the blood by injecting it straight into the veins instead of letting it dripped by itself from the beg.

in situations like this and in everyday life, i feel very useless if i just stand there doing nothing. since cpr can be tiring after a while, i asked if i could help them with it. and they allowed me to do it. i've done cpr many times on a mannequin but having a real dying person under your hands is totally totally totally different. i have no problem recalling on my earlier training but the difference between a dummy and a real life person is that you can break a man's rib if you do it to hard.

and thats what exactly happened to me.

i heard a bone cracking sound under my hands and immediately felt my hands tensed and turned cold. did i just break the man's rib??? the question kept on repeating itself over and over again in my head but my hand kept on with the compression albeit with lesser force. then this female doctor whooped my ass from behind and said, "eh kenapa lemah sangat?? you tak makan ke??"

"takut patah tulang dia nanti," i replied

"tak pe. kuat lagi."

so i went backed with the original force of compression but within a few minutes i heard the same cracking sound. and the whole mental torture raged on in my mind. i told myself it couldnt be a fracture cause the chest contour and resistance was still the same. i did it just so that i can continue with the job at hand and not be paralyzed with guilt and self-doubt.

after 30-40mins of cpr and other forms medical resuscitation, the guy's heart still failed to beat on his own and he was declared dead. his family members who were near the bed were informed of his death. we just moved away in silence.

at that point i was not sad or anything. i didnt even know the guy in the first place. i was just worried that i did more harm than good. and somehow or rather by my inexperince, i helped pushed him to the other side. these issues bugged me for two whole days. it kept on creeping into my mind and every attempt to shrug it off was futile. friends told me it probably the sound of the the bone moving in the joint space, just like when you crack your knuckles. and if it was a complete fracture, the chest resistance and contour would be different.

the issues was finally put to rest a few minutes back when i spoke to a dear friend who is practicing medicine in the UK. she said the A&E doctors there told her if you dont break at least a rib during cpr, you are doing it wrongly. it indicates that you are not compressing hard enough hence blood flow to the rest of the organs is insufficient. and judging by the severity of the patient's hemoptysis(coughing out blood) he probably had a couple of rib fracture from the accident itself.

whatever it is, it was a good learning experince. i just wish it wasnt such a traumatizing one.