Critical care
“I don’t think I will take your elective next year,” my groupmate rotating in TPDH-Surgery tells me on our way home.
For the past week, we’ve exchanged stories about our experiences for the day. Her stories range from horrific vehicular accidents to funny things people do that get themselves injured. My stories mainly involve double codes, intubating patients, crying relatives and preparing death certificates.
“I think if I were you, I would cry every day,” she continues.
I laugh out loud, and if I sound a bit hysterical in the end, I can’t really blame myself. “I do cry every day. Like, inside.” But once, I did find myself in the bathroom, crying. I wasn’t as strong as she thought I was.
This conversation would replay in my head on my last day in TPDH-Med. It was the first time I didn’t have to bring a death certificate for my consultant to sign. It was the first time no teary-eyed relative would approach me asking where they could get a CF4.
But I remember the last patient I saw before I left. He was a 73-year-old male who came in for tremors associated with falls and a month’s history of weight loss and anorexia. His CT scan showed an intracranial mass. He was losing parts of his cognition, but every time I would pass by and ask him how he was, he would give this wide toothless smile I found so endearing.
There was a small part of myself that was grateful that my rotation was over. He could get a stroke. It could be a neurosurgical procedure they couldn’t afford. He could develop pneumonia, then an acute respiratory failure, then instead of sitting gaily on his wheelchair, he would be GCS 3 (Glasgow Coma Scale) hooked to a cardiac monitor and a mechanical ventilator,
surrounded by weary-eyed relatives.
Did I want to witness something like that for the nth time? Not really.
But critical care fascinates me. There is a certain happiness that comes when I watch my patients get extubated and “downgraded” to the Medicine area. There’s an even greater satisfaction when I tell them they can finally go home after several days of confinement.
When the opposite side of this spectrum occurs and the patient’s relatives look at me for comfort, there is a bittersweet feeling in my heart. It moves me when they look for me to tell me what had happened (since I’m not always on duty to see to every code). It moves me when they hold my hand, and in silence I nod my sorry. It moves me when they find comfort in my words.
I learned about the comfort in words from the consultants I made rounds with each day. During one particular toxic day, there were three simultaneous codes. My consultant was commanding the code and using the ambu bag while I performed the chest compressions. One nurse was administering the doses of epinephrine. The other doctors and nurses in the ER were focusing on the two other codes.
On our side, the patient’s daughter was crying hysterically, telling her father to fight for his life. As the fourth cycle of CPR commenced, she held his hand and begged him to stay a little longer.
The whole time, my consultant talked over the noise in the ER. He explained how what we were doing should help the chances of a return of spontaneous circulation. Gently, he told her about the destiny of human beings and the limitations of modern medicine — that at the end of the day, it’s “the guy upstairs” who will decide when a man’s life will end.
He spoke to her with so much sincerity that when he finally called the time of death, the daughter rushed to my consultant’s side and hugged him tightly, thanking him for what he did.
It was an irony I can imagine myself living in every day — that sometimes we can still heal people even when the actual patient dies.
Maybe this means I’ll pursue that field someday. Maybe not. But either way, I learned a lot of valuable lessons in that rotation.
Kindness isn’t something dictated by a patient’s socioeconomic status, or whether we’re working in a public or a private hospital. Kindness is always a choice. No matter how toxic the duty days can get, good people are still good people, and I hope we always choose to be an example of all the good we have seen.
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Hazel Encarnado, 22, is a junior intern from St. Luke’s Medical Center College of Medicine.
