Close call

Always treat the patient and not the disease”… Profs words often ring in my ear when I find myself side tracked by signs and symptoms instead of the living, breathing (usually complaining) human being in front of me.

It was a clear and cloudless Wednesday night. I remember the eery feeling of the wind against my face as i stared across the dimly lit sky, to find a big red, blood moon staring back at me. A divine sign of the pending disaster about to approach me. Obviously, I didn’t take heed.

The incoming vehicle skided to a halt while the screeching of the tyres were blurred by the sound of pure agony.

The sound of a person dying. I suited up and grabbed my apron and visor while preparing myself for the worst. My heart thumping in the background.

I opened the car door to be met with approximately 2 litres of blood emptied onto my red nike takkies. I wondered if this man is alive as the blood kept collecting at my feet. My red shoes, A colour that was intentionally bought to cover up any rogue stains was now ironically drenched in it. The blood seeped through the cracks of my shoe lace and dampened my socks while I cringed. Nothing I could do besides worry about it later. I prodded on, leaving a stain of right red foot prints.

The gentleman wasn’t a day older than about 20. In fact it was his birthday celebration that went horribly wrong and caused him to visit us in such a dire condition. He was merry as can be, until an ex girlfriend downed too many vodkas and decided to stick a knife in his chest just adjacent to his heart.

His current girlfriend relayed this message in the highest pitch and tone available between helpless sobs, which defeaned me for a good few days.

The moment I heard his breathing pattern I knew he was in deep trouble. There’s a term we use in medicine to describe the breathing pattern of those on their death bed. “Gasping”. A sound i have become accustomed to hating.

The sound of oxygen leaving the body for the last time while I run around like a headless chicken attempting to force it back, Often failing.

The boys breathing was slightly more invigorated than a gasp but inevitably to become it. I was worried.

Drips were slapped on hurriedly and I threw in left intercostal drain to find the bottle gushing with blood. I was more at ease as I was convinced his condition was going to improve. It didn’t.

His blood pressure tanked further. His neck veins became distended and worst of all, his heart sounds whispered and muffled. I knew I was in deep trouble at this point.

A stabbed heart with a pericardial tamponade. The sac around the heart was filling with blood whilst it slowly began crushing the heart itself.

At a hospital, this would be wheeled into theatre while a surgeon presented himself to crack the chest open by doing a thoracotomy and repairing the stabbed heart and draining the blood around it.

Problem is i was at a clinic in the bush. Far away from any theatre. I looked at the monitor and watch the bp tank further.

“Doctor I’m dying” he squealed. I couldn’t even disagree. “Promise me you won’t let me die” . i nodded while intrinsically hoping I didn’t just lie.

I dialed the ambulance number and waited while i paced around. I booked a code red ambulance and said a silent prayer.

I knew what I had to do but the problem is I had never done it before. A pericardiocentesis. A procedure whereby you stick the biggest needle you can find into the heart space and drain the blood to avoid the tamponade from killing him. Problem is if you knick the heart, its over.

I prepared myself quickly as i knew seconds were of value in this case. I placed the needle in the subxiphoid window and prayed as my needle slid deeper into the skin. I aspirated until the back flow of blood appeared as i sighed with relief.

The Problem was far from over as the stab in the heart was still there, but we had averted any immediate death. The blood pressure spiked slightly and he breathed easier. Things were looking hopeful.

I called the ambulance again and the doctor on the receiving end. We waited.

His blood pressure began yo-yo ing and i knew it was only a matter of time before the blood in the sac would fill again.

My eyes and ears jolted as i heard the sound of a rusty truck approach. Finally, the ambulance had arrived.

I watched him go as they wheeled him off. I never heard or saw him again. I hope its because he made a full recovery and not the alternate.

Always treat the patient and not the disease”… Profs words often ring in my ear when I find myself side tracked by signs and symptoms instead of the living, breathing (usually complaining) human being in front of me.