When I started my career as a junior doctor, I had an idea of what my life would be like. I would awake every morning with vigor, motivation and excitement. I would fantasize about going to work and seeing the most interesting clinical cases known to mankind, cases I could only dream of.
Witnessing Physiology and pathology meet like a beautiful love story. I would have such a deep understanding of how the human body works and every possible thing that could go wrong with it and then how to remedy it. My insight into medicine would transcend every complexity, challenge and boundary. I would be physically helping people recover during their worst of times and still satiating my knowledge-itch.
What could be better? It would be the epitome of happiness for me.
But I couldn’t have been more wrong.
Little did I know, medicine would have its own way of bringing me to my knees, sometimes in an unforgiving and cruel way.
A conversation I had with a friend recently put this into perspective for me.
She narrated to me how she was upset about an issue she was having. She was a tennis fanatic and could not attend an out of province tennis match due to work commitments. She was extremely upset and angry. She had been planning to attend the tennis match for a while now. I understood her disappointment but not her level of emotional upheave. Afterall, its just tennis.
In that moment, I reflected on the past 5 days I had at the hospital and I found myself back there in my mind. I could still feel the fatigue in my periorbital muscles just barely keeping my eyes opened and the gloves on my hands.
The baby was just 7 weeks old. He had been admitted for an infection which wasn’t uncommon. We were on top of that and he had 1 more day of antibiotics to complete then he would be on his way home.
But something happened, we were not quite sure. We postulated that he might have had a massive vomit while asleep that leaked into his lungs causing him to choke and have a cardiac arrest.
When we found him, he was unresponsive. He had no pulse. He was not breathing. He was a corpse. He was dead. And the worst part was, we did not know for how long.
We were struggling to accept a healthy, well baby who was on the road to recovery was now suddenly dead. We could not let this go without a fight. I could not let this go. This is a life afterall.
At the time, I didn’t realise the war we had began to wage on death in that moment. We met death at a point I had often visited but never really acknowledged. A powerful and life-saving place I will remember for the rest of my days.
Afterall, I have had countless failed resucitations. Initially because I lacked good skills but I went out and acquired the skills I needed. Most times, the very act of needing a resuscitation is a bad prognostic sign because the baby is so sick. But this was different. This was something acute and so sudden.
Personally, Failure is a massive part of who I am in medicine. So many doctors view failure as a negative thing in medicine but how do they expect to learn? Is practice not just failure in a controlled environment? Ive learned to seek failure and relish in it. I find it and build on it so I can use it as my baseline to move onto the next level. Failure helps me live at the edge of my capabilities so that I may fail, but fail forward.
I cant do this? Then I have to.
I don’t know this? Then I must learn.
Ive tried to apply the general rules of failure to my life. My time in medicine has just been a series of failures- often, early, daily, progressively. And I am a better doctor and person for it.
Initially When I walked into ICU and found my colleague commencing the resuscitation with chest compressions, my heart immediately fell because I knew this meant his heart had stopped, a bad sign from the beginning. On top of that I had been suffering with an intense prolonged migraine for 2 days and I was physically not at my best. But This gave my adrenals the good old push it needed and I could feel my pulse bounding and my migraine take a backseat.
We tackled the resuscitation with intensity. Chest compressions on point. We struggled with an IV line and we could not source an intraosseous needle quick enough, so I put the biggest needle I could find directly into the bone and pushed adrenaline into the bone marrow, hoping it reaches the heart to help it to pump. We were relentless in our resuscitation. Multiple doses of adrenaline. Wrist spasms from compressions. Sweat dripping from my forehead into my mouth. We got the intubation trolley early and quickly.
I opened his mouth and felt my grip tighten around the handle of the laryngoscope. I paused as I searched for the vocal cords. As I visualized the cords, I saw the half-digested curdy milk pooling just below the cords and my heart further sank. The lungs were drowning in milk. He was literally drowning, suffocating, hypoxic, suffering. I suctioned tons of milk out of the lung. We persisted with the resuscitation while bagging him with oxygen through the ETT. At some point we achieved ROSC(return of spontaneous circulation) and the pulse was 40, still low.
We were not winning 15 minutes into the resus. We exchanged looks but no one was willing to give up. Instead of deflating, we inflated our efforts. We pushed the sternum harder. Co-ordinated better. Had another dose of adrenaline. Bolus given. We continued in silence.
20 minutes later, by some divine miracle in our hands, the baby had improved. We knew the risk of having neurological deficit was there but we could not stop for “what if’s” and “could have’s”.
We subsequently put him on life support and allowed his lungs to rest.
He did well after being taken off and is currently healthy and well which is remarkable.
This prompted me to think about the cost of a life.
What is the price of a life? What would be a near-equal trade- off?
If we had given up on the resuscitation or given it a half-hearted effort and the baby had died, what excuse/reason would justify that?
Is fatigue, exhaustion, a 2-day migraine, resource limitation, an overburdened healthcare system, poverty, disease with no end, preventable deaths, depression and anxiety in the workplace…is this the cost of a life?
I feel like Paediatrics is filled with small happinesses. Successful IV lines. Smiles. Getting a wave back after you poked the children. Good CSF back flow. Then you have 1 death and it drowns all the happiness out. The pain of 1 death is not worth the happiness of saving 10 lives. But we persist daily in search for those small happinesses.
What else can we do?
So I thought about the predicament my friend was in and I looked her dead in the eye and said,
“NO. ITS JUST FRICKING TENNIS!!! ”.