Things looked fine to go, gear shifting into work mode seemed smooth without a migraine threatening to make its ugly head visible. My intern was choosing his poison at the Cafeteria and as languor spread into my synovia and cerebri, I choose to surf cricinfo while on call!!!!!!
Post arrest hypothermia- still cooling, diverticulitis- stable, bleeder- not bleeding, DKA- miles to go for the gap to close, bleeder with MI- not bleeding, not aching; COPD- vented; hemothorax- tube's draining less and less.
"All looks okay", my intern said.
" I concur doctor", I wheedled to humor the dude. Asinus asinum fricat.
Timepass yields to the ultimate timepass of our times-Twitter. I am then directed to George Orwell's essay on Gandhi circa 1949. I am smiling to myself.......
Then shit happens.
I get a page for tachy. My bleeder is bleeding. Instinctively I want to rule out some stuff-MI?PE? - EKG, enzymes, CBC and the works are sent out. We decide to block some mischievous cyclic AMP molecules that are driving the heart whiny with some metoprolol.
Not such a great idea, it turns out. Blood pressure plummets.
Fluids pumped in, blood on the way, pressors pushed into weeny IV lines- she pinks up like a Plumpelina. I am talking to her daughter, some fights between GI and surgery and interventional radiology about who bites the bullet first and plunges into the bloody field first. I am appalled!!
Pressure drops again. This time fluids are followed by levo, neo and then epi drips. She's mottling, holding her belly, looking the way I recognize bodes ill- it reminds me of the picture in Bailey and Love of a patient with pneumococcal peritonitis. It is clear she is exsanguinating faster than we can arrange for her to have any intervention. Sadly a 'code status' discussion makes sense now. I ask," do you want us to operate on you and try........."
I am not sure she heard or understood me. She said, " I do not know....." like she was talking to someone at the end of a long tunnel, each blink of her eye taking away more of her remaining life away. Suddenly she looked every bit of the seventy some years she had managed to hide in her charming demeanor and away from the tar and nicotine and ethanol that also were in her medical facebook profile. I talked to her daughter, and in explaining the "chances" I had to check myself against using colloquial nonmedical words in trying to tell her that her mother's age was a big prognostic factor.
" Is it fated?" , I was asking myself.I was reasoning back like there was an itch in my cerebrum I wanted to scratch out. How could I think so? I could clip, sclerose, inject, coil, embolize, operate. Why was I thinking like a baalu baccha? Or was I?
With all the advances of modern medicine, and all that I have at my back and call, have I got to stop at some point in time and take a breather and say Ohmygawd, what a monstrosity we have created in thinking that we are immortal. and can mend and heal all that looks like a mechanistic peg hole.
" But she is awake ", Jen, the nurse shrieked. "How can you make her comfort care?"
" But she is on her way"
" You can't let her pass this way", she reasoned.
" Even I thought so, initially", I blurted back.
With all my cultural differences, cognitive biases and representativeness heuristics, I felt here, I was the wiser one.
We gave Ms H some Morphine so that she could sleep through the blood flooding her lungs and her heart feebly stammering to a flat line. She looked peaceful as she gave me one long look through her ashen eyes and blinked one last time.
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