When the going gets tough… (III)

The night before Jeenal was to follow up with the unit head, she presented to the casualty with weakness and pain in her belly. She had been running a fever throughout the day and felt uneasy and giddy. Her mother called the unit head, who advised her to come over to the hospital as soon as possible.

Before she could reach the emergency surgical ward, Jeenal had collapsed. She was unconscious, her fever now transmogrified into an eerie coldness, a sure shot sign of a drop in blood pressure. Her pulse rate had slowed down and acquired a feeble quality. Sweat had started dripping off her brows and forehead, a cold sweat, one that made every attending doctor nervous.

Jeenal took laborious breaths, and with every passing moment, it became obvious that she required artificial ventilation.

Even though the on-call unit wasn’t the same as the one that had treated Jeenal, they still knew how special this patient was.

Jeenals blood pressure was unrecordable, her heart rate had slowed down dangerously, and she had become incapable of breathing independently. The ABCD approach (A-airway, B-breathing, C-circulation, D-differential diagnosis or disability assessment) mandated an endotracheal tube to be placed in-situ (a tube that entered the airway through the mouth and provided air directly to the respiratory tract), followed by artificial ventilation with an AMBU (ambulatory mobile breathing unit), and eventually the placement of an access line into the neck veins, in order to infuse fluids and drugs to maintain the circulatory system.

 

After initial stabilization, Jeenal was shifted to the SICU (surgical intensive care unit) and placed on ventilatory support.

She was in a state of septic shock, a condition wherein the infecting organisms released proteins into the circulation to activate various immune defense mechanisms, which when over activated, can cause more harm than good.

It was strongly suspected that the anastomosis performed during surgery had given way. The sutures that held the tissues together had fallen apart and caused all the organisms within the gut to spill out into the abdominal cavity. The only option left for Jeenal was another surgery.

The sutures had indeed given way, as could be seen during surgery and her entire abdominal cavity was filled with the toxic substance, bile, an agent so corrosive that it could cause even the skin to break down when applied over it.

A through washout of the abdominal cavity was performed along with a restructuring of the failed anastomoses. Even though the procedure had been performed fairly quickly, Jeenal continued to remain unresponsive and passive.

 

I saw Jeenal in the SICU the following morning. Her hair had been oiled and tied back, her eyes were padded with moist gauze to prevent excoriations on the exposed parts, a tube stuck out of her mouth and connected to a large machine which beeped constantly, the ventilator.

The smile that adorned her face, when she was leaving to go home, lingered on in my memory. But, all I could see now, were a pair of dried lips with crusts on them. Her face was expressionless, and her hands tied to the railings along the side to prevent her from pulling out the tubes, but it seemed unnecessary. This was the one time that I hoped for one of her tantrums or an angry outbursts, but none was forthcoming.

Her mother came and hugged me. She was inconsolable. She cursed their poor luck and herself, for giving in to Jeenals demand to go home earlier than the doctors would’ve liked.

I spent the day moving in and out of the SICU, running personal errands for Jeenals family and hanging around to support them.

Jeenal life support system was the only thing that kept her going. There were four infusion pumps, six stands to hold the intravenous fluids and drugs and a colossal ventilator that surrounded her. Above her lay the pulse oximeter and electrocardiographic monitor sending out multiple channels which lay haphazardly over her chest.

At 9:40 pm that evening, two days after Jeenal had turned twenty, her heart, which was being flogged like a tired horse, gave up. The monitors showed us a flat line and she had stopped breathing. Dr. P and I were both present there at the time, and tried everything we could to revive her. But it was all in vain.

Jeenal had passed away.

Her mother and brother were heartbroken and Dr. P was gallant enough to offer them support.

A terrible gloom fell over the unit and the surgical wards after Jeenal passed away. Such was her presence, such was her power to liven up a conversation, such was her grit, to go through it all before she even turned twenty.

 

Could we blame her luck, her stubborn nature, the surgeons expertise (which was never in doubt), or just fate!

A surgeons knife is a powerful tool. Not only can it heal and cure, but it can also complicate and kill. The cure rates are always higher than the rate of complications. But, that single complication can prove to be fatal.

 

Some patients just disappear after treatment and are forgotten, some valiantly escape death and immortalize themselves in the hospital folklore, but a minority group of patients continue to linger on in your memory even years after they move on.

They aren’t the strongest, bravest and haven’t necessarily escaped death. These patients may have given you a terrible time whilst under your care, but they’re the ones who stand up and truly take it in their stride, when the going gets tough!

 

(The End)