Imagine you’re standing at the edge of life, just about to breathe your last. The air around you is cool and time begins to slow down. Everything you have ever been, said, thought, learnt and done, is finally coming to an end.
You look around you because the Godly light above you is blinding. You hear voices and gentle sobs. you hear prayers and feel warm palms against yours.
Then, you hear Me. Screaming- for more IV lines. Asking people to get strapping and more gloves. Tainting your peaceful exitus with loud and unruly comments.
This reminds me of a day during my community service.
I met a gentleman who was on his way out. Of this life, that is. His grey streaked hair was a sign of the life he had once lived and memories he had collected. His soft brown eyes told a story of a life well lived. His wrinkles dug deep into his forehead as he groaned in discomfort.
It was Unfortunate that we had to meet at all. He had now ended up on my side of the woods because he had developed a lower gastrointestinal bleed which basically meant he was pouring blood out of his rectum.
It was during my community service year and I was based at a busy rural clinic, far away from the suburbs and picket fences. The clinic was always busy, dusk to dawn. Patients flowed through, uncontrollably. We had encountered bouts of hijackings early in the year which was fairly common in south Africa, so I was never really surprised.
But everyone else was. It seems like other people have a sense of self-preservation and feared for their lives, so ofcourse, 3 doctors had left, leaving 3 behind. To start off 6 doctors were considered understaffed but 3 was just ridiculous. But We soldiered on with no other real option in site. Here lies the problem.
The said gentleman happened to be visiting an old friend of his When he found his behind in a pool of blood on his car seat. Naturally he was surprised and rushed to the nearest clinic and found me.
Our humble facility was ill prepared for bleeds of any kind. We had IV lines and normal saline- salt water. We had no blood bank, no surgical theatre and no surgeons. All the bare minimum to handle a bleeding organ of this magnitude.
I stood there quite depressed and hopeless, and it showed. The gentleman was worried and so was I. I dug deep into my minimal knowledge of lower gastrointestinal bleeds and did a quick calculation in my foggy mind.
His ward hemoglobin read 8.5. He bled approximately 1.5L already and he showed signs of hypovolemic shock. His pulse was climbing to 180 and his blood pressure was sinking quickly. I was worried.
I decided to start the resuscitation with 2 wide bore IV lines and started pushing the salt water hoping for a magical turn around of events. It never came. As I pumped more saline, his rectum and anus poured more blood. A small puddle of blood collected on the bed beneath him.
My cortisol levels soared as i felt the adrenaline pump my heart into over drive. I decided to assemble a make shift theatre at the bed side and explore the anus under direct vision.
I set up a semi-sterile area and I triple gloved. My face protector was on and my light was positioned. I explained to the gentleman that id need his full cooperation while i tried what i could to find the bleeder. He looked embarrassed but fearful. He agreed.
I positioned him and said a small prayer. In I went. I inspected the outside and nothing was grossly abnormal except for the small stream of blood spitting out the anus. I plugged it with a gauze piece and waited. Success.
But not for long. It soaked up a weak stain of blood and fell off. I plugged it with my finger and waited. It seeped out through the corners. I concluded that the bleed was from the colon which basically means I was screwed. I couldn’t access that far up. Not even near.
I looked at the tray in front of me and I told myself to think fast! Somehow that made my brain freeze under pressure.
Working in a rural clinic with minimal resources and no fancy necessary equipment usually means you have to use what you have to do what you must. I embraced this concept and began to formulate a plan.
The plan in my mind was simple enough. Tamponade the bleed with pressure just long enough to get him to a surgeon, sounds easy. I began searching for something stretchable to do the trick.
I positioned a glove at the anus and shouted for a normal saline bag. I began running fluid into glove but the bulky nature of it proved unworthy. It slumped out the anus and poured blood all over the floor.
I looked around and searched for something, anything. Desperation took over. He groaned. He looked pale and clammy. His peripheries began shutting down. His blood volume became weaker by the second. His breathing became shallow and fast as acidosis took over.
I ran to the entrance of the Door like a mad man, looking for an answer and I found it. I grabbed a condom from the free dispenser and inserted it into his anus and connected my saline drip as it filled it to capacity. Expanding and plugging the bleed of the canal. I taped the hole shut and hoped for the best.
I called the ambulance and waited. I pushed more fluids but things were looking bleak. The gentleman slipped into a slow state of incoherence. He sobbed quietly and in vain.
I covered him with a blanket trying to preserve what ever dignity he had left. I felt guilty and hopeless. The bleeding eventually stopped. But not in the way i had hoped. His body became stiff and his pupils slowly dilated.
I thought of a joke an anaethetist once told me which wasn’t funny at all in this case. “All bleeding eventually stops”.
Amd he was right.The bleeding eventually did stop because his heart stopped. His organs were deprived of blood and he eventually died right infront of me, in my hands.
The death really affected me in the weeks to come. I wished he didn’t have to meet me. I wished he didn’t have his exitus ruined by my invasive efforts. And I wished i could have done more.
But I reminded myself that I had to try.
After all, What else could I do?
I couldn’t risk playing with people’s lives by not trying.
After all, I wouldn’t be able to live with myself if I didn’t try.