Tuesday, January 10, 2012

Tapping the vein, looking for a juicy one, my head spinning from the turmoil of the previous night, I still smile as my phone beeps. I've got you to go home to, see. Then I think back on the previous night.  Blood taking is very mechanical, small talk required, but it gives room for the tired mind to wander.

The patient was desaturating, 'Tukar high flow mask' I say after listening for ronchi or prolonged expiration. The nurses are well versed, they've already set up the crash cart and he's on the cardiac monitor. 'Boss, I'd like to inform you...' I say over the phone not knwing the patient's going into asystole. I rush back and climb onto the bed to do the chest compressions which many people argue is life saving, but in most cases I've seen it's more of a life prolongation. GCS dropping,intubation required, the MO has arrived. Fluid already being run, patient maxed out on triple ionotropes we get a bradycardic pulse. Arms heavy from fatigue we scramble off the bed and squint at the monitor. Is that a rhythm? Do we need atropine? Then heart rate becomes zero again and we do chest compressions again, patient's heart is stubbornly in asystole. 30 minutes, 40 minutes, the surrounding patients are hushed, suffering qualms of fear at the impending death of a fellow ward-mate.

I don't want my loved ones to spend their last few minutes like that. I've seen enough in the last few months. I feel the helplessness of family and slight glint of (?misplaced) hope as we ask them to stay outside while we resuscitate. Up to today I still tear each time it happens.

As the rib cage becomes more yielding under our persistent compressions, and the pupils become fixed dilated from a previous sluggish response over 2 days, we know our chnaces are slim for the patient to wake up and smile at his family. We know. We tell the family. DIL issued we say. Dia sudah tak ader  we say. Tindakbalas terhadap rawatan sangat kurang, jangkitan kumannya kuat sangat. Each time I say it something twists inside of me. Could we have done more? It's a life. It's a person someone else loves.

I don't want my loved ones to go with an NAR, nor do I want them to have tubes stuck down their throats or central lines flushed with drugs that give us a false impression of haemodynamic stability. I dont want their last active thought to be that of a tired medical worker shining a torch into their pupils or palpating their carotids. I dont want people to stick grey branulas into their groin area as they try for femoral lines when the BP is already spiralling downwards. I dont want them to suffer. But I will be damned if I signed an NAR and didnt try for that slight possibility that I might spend another 2 minutes with someone I care for.

Essentially to me, that's what CPR is. a temporary prolongation of live, and thne if God willing and the patient has what it takes, he/she survives and we medical workers have one less heartache. Don't be fooled. We feel for each person we care for,  whether he's an innocent or crimina, whether he's rich or old, or whether we like him/her or not.

So yes, I am against NAR, unless the prognosis is really horrendously bad. Until then, keep resuscitating. I prefer my people alive.


Angel said...

I know exactly how you feel... I've always wondered whether CPR was just temporary prolongation of poor quality life. Of all those I've resuscitated, 55 lived to walk home, hand in hand with their loved ones. And that makes the effort worthwhile.


Loshini said...

dear angel, am glad there's sumone who can relate :) you tc too..