Aug 3, 2015

A Death in ED

There is death waiting and lingering around the corner. You never know it is there, even when the torrents of fate whisking the life away from him as clearly as the rage of midyear's monsoon. You see it with your eyes, like a spectator too horrified at what they are seeing but seemed unable to tear their gaze away, of the sequential events unfolding in front of you. You have an inkling in your mind, that one of the outcomes of this is ultimately death. Revival is another, being in a critical is another. But as long as Izrail has not arrived, you never think that death can come as swiftly as a thought.

You think that it is impossible to happen. Well, not impossible, but highly improbable. He was fine when he came in through the door. A grazed wound on his shoulder where you can see red, angry patches of what the skin should have been. His shirt was torn at his back, and from the say-sos of those in the room you found out that he was brought in due to a motor vehicle accident. A bike versus a lorry, and only a little skirmish from the look of the wound unlike the horrible, terrible accidents where bones meet outside air and scream is the language of pain. He was on the stretcher but was well enough to give his ID for identification. Hope is aplenty at that time. Triage coloured him amber, not knowing that Izrail does not pay heed to hopes and favours of men.

His visit did not take long before the rest know that he was there. The man was losing his consciousness suddenly and rapidly before he even arrived at his bedpost. The stretcher bed was pushed quickly back here with one of the doctors shaking him non too gently and pleaded him to stay awake. A houseman jumped to the bed and started to compress his chest even before the bed had stopped from moving. The pandemonium erupted as rapid sequence intubation was performed and the adrenaline was being prepared. You hurriedly took a pair of gloves and one of the housemen handed you an apron. The mask plastered on your face remained fixed there as if to shield away from the oncoming fears that started to creep in. 

You wished that you can stay aloof as the others; they must have stare deaths in their face too often to be shaken by another one death. But deep in your mind you are more rattled about the fact that deaths no longer shake you. Not completely. Death is the only certainty in this world and none other. You tried to dismiss the disturbing thought and it went away, like one swallowing a bitter spit. Yet you could not stop from wondering, when will death finally take a hold of you completely, ripping you off from your stone-heart foundation of emotions?

You heard and noted the order: "One, I clear. Two, you clear. Three, all clear." before the patient jumped from being shocked. The line on the screen remained flat and refused to form wave-like patterns. You know from the protocol three shots of adrenaline must be given, and it was already the second shot. "Change," the order for the next person to resuscitate was given out and you stepped on the stool beside the bed. You recalled seeing the previous two attendants giving the compressions at such a rate that you thought it was impossible for the heart to be coaxed to beat again. And you pushed as hard and as fast as you can.

You were thinking about the first and the last person you gave chest compressions to. He was also on the bed, surrounded by people trying to resuscitate him. You remembered that you could not stop from looking at his face as you resuscitated him, thinking that at any moment he would be revived at your touch. So this time, as you pushed and pushed, the blades of your shoulders were pulled back and your arms straight, and you kept looking at the cardiac monitor, wishing fervently that the word ASYSTOLE and the blare of the beep would disappear. After a couple of minutes you were changed by another and you waited for your next turn, and even then and two shots  of adrenaline later, he was not revived and the rest had come to an agreement.

The doctor looked at the watch on her wrist and mouth the time of death silently. In the midst of resuscitation no one could actually know when Izrail came and left with the patient. All that you know that he was there and he has left with what he came for. The order of business toned down considerably, after that. With nothing left to do, you took off your gloves and apron and discarded them into the bin before you walked out to see another patients.

The patient did not come into your mind until much later when you walked along the path that connects the two zones. You walked past the isolation room with the doors open and you saw the son standing over his father's body, now laid safely and seemed at ease on the bed. The son was teary, his eyes red and his breath rugged, his face crumpled with sadness only those with losses can understand. As you walked you tried to dwelt in his sorrow, thinking that death can come as surely and as swiftly without a warning, and you wondered in contemplation about the nature of death that awaits us all.


He had line inserted and blood work was carried out. Deceived by the outward appearance, they disregarded the warning sign of hyponatraemia (120) and sent him for x-ray imaging. It was during that time, the sudden movement marred with the the level of sodium in the body that caused him to have a seizure. And once you have a seizure, the chance of a successful resuscitation is low.

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