The First One

The First One.

I suppose I shouldn’t be surprised that it happened in Kenya.

I went back to the hospital this afternoon with Kelly and Amy (2 pharmacy students) to admit some patients and follow up on some labs, etc.

I had just gotten done admitting when Kelly asked me if we could check an oxygen saturation on an asthmatic patient of ours who is in severe respiratory distress. We finally tracked down the pulse ox machine, and got her sats at 92%, which isn’t too bad considering how distressed she looks.
We were getting ready to leave when a nurse came up and asked us to check the sats on another patient – someone on the other firm’s team, not my team. We went over there and were not able to get a reading on the machine despite trying for 5 minutes or so. The nurse told us the patient was 55, HIV+ and currently on treatment for PCP (a type of severe pneumonia that immunocompromised patients get). She was on an oxygen mask, and her bed was in the middle of the cube because she was in the process of getting transferred to the ICU.
All of a sudden the woman stops breathing, and we can’t find a pulse. So the nurse asks us to get the intern. I run over to my intern, who’s admitting a patient, and he points across the room and says – “that’s the intern on call tonight.” Very nice. So I go up to this guy, tell him there’s a patient (of HIS, mind you) that has no pulse and he says “ok” goes about his business and doesn’t come with me. So the nurses are looking at me to do something, they wheel the bed back into its corner, and I started doing chest compressions.

As soon as the intern walked by and saw me doing chest compressions, he dashed off to get a bag mask and came running back.

We did CPR for about 15 or 20 minutes – me doing chest compressions, the intern giving breaths and Kelly pushing the drugs. After countless rounds of CPR and 2 rounds of drugs, the intern was ok with declaring her.

So, I wrote the death certification. And after it was all over, I cried. A lot.

The first patient I’ve been with when they died, and I don’t even know her name. When I was in the NICU in June, we had 2 babies die, but by the time I got there the pulse and respirations were already gone, and resuscitation was already underway. These babies were intubated and sedated as well – from the moment of their births in fact – so I suppose as a defense mechanism I never really thought of them as /alive./ Today, this patient, was the first time I have been with someone as they crossed that mysterious and universal boundary between life and death. I’m sure it won’t be the last.

I guess the one small silver lining of this cloud is that I was really able to remain calm during the whole ordeal. If I thought about the fact that it was me (a medical student) and Kelly (a pharmacy student) in charge of the resuscitation from the beginning, I probably would have had a panic attack.

All of our CPR and ACLS classes seemed so excessive until now – you learn so many different algorithms and what to do in a code situation, but I was surprised how much of it came back to me – the endless cycles of 15 compressions to 2 breaths, give epi and atropine, check pulse, check breathing, repeat. You have to become a robot in those situations, or I think you’ll just go mad.

During, I asked the nurse if she had any family around. The nurse said “yes, a daughter.” I asked both so we could tell someone and keep them away at the same time. It really hit me afterwards, as they looked for her daughter, that this was a life, a human life. Someone’s mother. And we couldn’t bring her back.
I don’t know, I guess you can try to make sense of it all, or do as the Kenyan’s do and just accept that death is a part of every life. Maybe it’s a little bit of both. Or maybe, we all have to find our own path to understanding the horrible things that happen in this world, and we have to find a way to do that without becoming emotionally crippled for all our lives.

I think today was the beginning of my path to that place…wherever it is…