DOA

I remember fondly the words of a Prof whom i once knew, “Everyone deserves a resuscitation. Everyone deserves a fight for their life”.

This particular Prof was the rare kind of surgeon. Extremely soft spoken and always willing to teach, albeit on post call ward rounds when everyone was sleep deprived and starving. Everyone who knew him loved him, even the theatre staff. If you’ve ever seen the operating theater dynamic, you’d know that is a big accomplishment. Between surgeons storming in and opening abdomens, they also want their favourite instruments and the scrub nurses to dance to their mad tunes.

After observing many surgeons, I’ve come to the conclusion that the measure of a surgeon is in how he treats the theatre staff with whom he operates. The mannerisms in which he conducts himself under tense situations is a tell-all. For a surgeon, his theatre staff know him better than anyone does. The man in is home on his supper table is one person. The man inside an abdomen at 3am is someone else.

The scrub sister knows how he prefers his instruments handed to him, left or right. which suture to open first or if he is using skin clips or staples. The most intricate details of how you operate, cut and sew. She knows your hands, mind and capabilities in a way no one else ever could. She is the well lubricated oil to your cutting engine. In fact it’s my personal belief that a good scrub nurse can be a game changer for any surgeon. The bleeder you can’t see, she’s dabbing prophetically until you hear the cautery doing its job. The abdominal washout you’re doing, she spots more pus. The bladder shes retracting, clears your view. The serosal bowel tear you’re searching for, she spots from the corner. The baby’s head who needs maneuvering out of the uterus, her hands are there.

The scrub sister is beside you during the gore of losing a patient and the glory of your success. She carefully cleans and drapes like a well orchestrated dance, then ready to clean up after you flop your gloves off. She’s there well before you start slicing and after everything is over.

If you cannot respect the theatre staff in their domain, how can they respect you as a surgeon?

Anyway, I digress. This particular Prof was so well mannered and respected, even in a busy, adrenal racking surgery, he always managed to rally the team together. I must admit I learned a great deal about the level of decorum and decency that doctors must carry themselves with, from him.

It was him and his mantra of fighting for every human life that made me despise a DOA- dead on arrival.

The very concept of a person being rushed into an emergency department lifeless triggers all sorts of alarms for me. We live in a country where the vast majority of people rely solely on public transport to move around which can obviously be problematic in emergency situations.

Can you imagine yourself sitting at home enjoying a quiet dinner when suddenly you experience a simmer of pain on the left side of your chest. You brush it off as heartburn and continue to chew. Then it hits you like a wave of daggers through Your heart. The pain causes you to drop to the ground and wail.

Your spouse arrives on time to find you clutching your chest wall. You phone an ambulance but the pain is crippling. You don’t have a car. You cannot think about a hospital plan when all you can afford is bread. You are forced to phone a friend and wait, or worse, look for a taxi while your myocardium dissipates into a necrotic mess. Can you imagine this? You shouldn’t have to.

The old man didn’t have to imagine. I met him at the gate while I was walking out, when the taxi announced short left, and pulled up an inch from my face. He was offloaded into a wheelchair which had to survive the potholes of the road and the rocky terrain.

I tried to move him onto a stretcher myself but he was drenched in sweat and urine, so my gloves kept slipping off. We got him into a stretcher and the long resuscitation commenced halfway on the road.

He was obviously having a heart attack. His body was stiff from pure pain as his hands buckled at his chest. He was slipping into a deep coma just as we shuffled past the emergency department doors.

I refused to allow him to become a “dead On arrival” case but His pulse became weak and thready, his hands fell limp. He stared into the distance before closing his eyes.

I wandered what his last thoughts were. Did he think about his family? Was he afraid? Did he think about his bank balance? Or was he just accepting of his fate, i will never know.

Theres some thing chilly about holding a defibrillator. The thought of shocking a person back to life seems far fetched. I hoped it wasn’t. I placed the paddles on the patient and said a silent prayer as i charged and shocked.

Nothing. His muscles stiffened and his face grimaced.

I pushed the tube down his trachea and watched his chest heave with air with no palpable pulses. I continued CPR for 1 hour after which there were no recordable vitals. I felt the tears wet the inside of my N95 mask as I realised I was doing chest compressions on a corpse.

I found a nearby foot stool and placed my behind down. I began counting the number of IV lines lying on the floor and the blood splattered beside it with shattered adrenaline viles. I could hear the suction machine rumble and the oxylog pump oxygen into useless cells. My own breathing slowed down as I felt a wave of indescribable sadness fall over me. I was used to dealing with the sick of the sickest. I was used to being in a deadlock with the grim reaper. Him pulling, me pulling harder. I was used to looking for veins, starting drugs, pushing normal saline boluses, standing on beds to move fitting patients into the left lateral position, completing tons of admin work to make sure patients were being referred to the right place. At least I was doing something.

I reached for the file and began writing down the events which occurred. I ignored the shuffling across the room whilst I wrote.

Then I heard a pop and a groan and a thump. The Man was in hand floor and pulling the tube out like old plumbing.

I screamed.

I screamed again. I scanned the monitors and realised he had made such a remarkable come back, his heart was beating, at 30 beats per minute but still beating. Could this be the after effects of the adrenaline? Why was he conscious? Isn’t he dead?

His wife ran in and began sobbing litres. She fell to the floor and prayed incessantly thanking every ancestor she knew.

I couldn’t believe my eyes. The man infront of me was dead 5 minutes ago and now he is sipping on an orange juice with a heart rate of 45. I was dumbfounded. I referred him to the district hospital and hoped he made it.

Prof would have been proud of me, for fighting when there seemed to be no chance. I could feel it. And I won.

But as usual as life has the last say, Prof passed on the year I began my internship. I was told he passed away at home in his bed before he could reach any hospital. A suspected stroke.

I can’t help but wish i could have fought for Prof’s life, and given him the exiting courtesy he so rightfully deserved. I would have given the grim reaper hell.

But he taught me how to fight for every one elses life, and for that i will always be thankful. I learned never to give up even when we think there’s no hope or the circumstances lead us to believe so. Put the effort in, life and humans may surprise you.