last memory before you die

It was a busy night in St Elsewhere’s, my last night shift at the hospital. It was always going to be, the first ‘business’ day after a bank holiday weekend. It was just madness.

During the night an emaciated man came in by ambulance, the reek of feet and urine followed him like the wavy smell lines from Pig Pen in Charlie Brown comics. He had called the ambulance himself complaining of being non-specifically unwell. When they arrived he was found in a house full of empty soft-drink bottles; not the greatest given that he was a diabetic. Aside from being a little bit dehydrated and having a high sugar, he was fine. Most of us presumed he was in a mild case of Diabetic Ketoacidosis. I’ll stop here for a second. Most medical people will say that there really isn’t such a thing as a mild case; there are degrees, but I digress. His pulse wasn’t too rapid, his breathing was at a normal rate and all his other vital signs were normal. As such, we bumped him up the triage list to be seen sooner, but given the sheer volume of patients in the dept. it would still be a while before we got to him.

He was parked opposite the nurses station on a monitor. Intermittently he would pretend to have a seizure, which would remit when we walked into his cubicle and told him to ’stop it’. At some point during the night, just about all of our staff had walked in at one point and told him to stop being ridiculous and attention seeking!

As it turned out, it was a while before he was seen by one of the doctors. Bloods were taken, we checked the acidity of his blood (normal) and started him on an insulin drip (to replace the insulin which diabetics can’t produce on their own). After being seen by the doctor, he became increasingly obnoxious and demanding, which resulted in more stern words from us and veiled threats of calling the police to have him removed…Still his vital signs were normal. His blood tests came back…His electrolytes were all out of whack in a way that would be incompatible with life. His kidneys had failed. He had had some damage to his heart and his sugar level was the highest I have ever seen. He was promptly moved into our resuscitation area where we could more aggressively treat him. By this stage it was morning, the day staff were just coming on, torpor had set in from a night that had been literally non-stop over 12 hours.

‘Registrar to resus, registrar to resus.’

It’s a call over the loud-speaker in the dept. which usually means that the proverbial had hit the fan. It had.

Our man had suffered a cardiac arrest. The man we had been rude, abrupt and dismissive to had died. He was difficult to intubate as vomit was cascading out of his mouth with CPR. After 10mins we got him back…just…We tidied him up a bit, continued to aggressively attempt to correct everything that was wrong…he had another cardiac arrest…we got him back again…We sent him to the intensive care unit where he had a further cardiac arrest…

All night he had watched us walking past him, occasionally rudely telling him to ’settle down’, ‘be quiet’ or just plainly ’stop it’. All night his body had been slowly shutting down. All night it felt like we didn’t do much about it.

~ by Dr Ben on June 7, 2007.