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First Night

August 2, 2010

“Doctor, doctor, we have a man on the ground! Come quickly!”

I was the intern on call that day, and was observing a resident taking a history from a new patient. It was my first call night, and the whole hospital had a different feel to it; the busy halls in the morning were then silent. The staff filling the long corridor was reduced to a couple of nurses and doctors on call.

The resident was examining the patient, when I wandered outside the room, and I heard a lady calling…

I thought the man she referred to was a patient in a room, and I rushed out.

“Where is he? Which room?”

“He’s in the corridor! His mother is in bad condition.”

I saw him, sitting on the ground, his back to the wall, in obvious distress. His family were all around him. He told me to get him something to sniff. I thought he looked okay.

I turned around, thinking what I could get him, but also thinking what I should do (Doctors are not super beings , by the way.) I thought, it could be a seizure, or a vasovagal attack. I quickly went back and checked his pulse, and listened to his heart, everything was okay.

“Give him a sedative, doctor. I’m afraid he has a severe episode.”

But of course I’m not authorized to give any sedative, but he needn’t any. So I calmed her down, and told the guy to drink some water, and go out get some fresh air. The resident was finished by then, and he concurred.

I went to check on the guy’s mother, and I found another resident standing above her, listening with his stethoscope, and a couple of nurses, one was pumping air into the patient’s lungs.

“Why don’t you take over the bag? The nurse looks tired”

I took over. The patient was lying beneath me, her eyes, lifeless. Wires are coming out of her chest, connected to an EKG monitor, which is showing regular heart activity. I was told she was a breast cancer patient, with the tumor spread to her liver, and that previously, both her heart and breathing had stopped. I could see her son outside from the window.

It has been 45 minutes since the beginning of the CPR, frustration was palpable. But the resident was keeping things going, he wanted to go on as long as her heart worked, even though her brain has probably suffered irreversible damage. I was looking at her, maybe there was a one in a million chance, but why not work for it.

The surge of emotion was incredible, to have a life of another human in your hands, the chance to save a life, was overwhelming. It is simply un-explainable, I couldn’t get it until that day. The idea that I might do that for a living was so deeply satisfying, and comforting that I have made a good choice, even with all my struggles.

Ultimately, it doesn’t always work out. There was an episode in ‘Scrubs’ where both JD and Turk got to save people from death, and basked in all the credit, but then Eliot’s CPR patient died. Well, our patient did not die, but was sent to the ICU with no signs of improvement, I can only hope she lives.

The more I do it, the more normal it will feel, I guess. But I don’t think this will be a day I forget easily.


From → Life in Medicine

  1. I do not and probably will never understand how can you people operate under such emotionally stressful circumstances. I guess developing a sense of isolation between feeling for patients and treating must be a critical skill for a doctor to pick up!
    Am glad you’re finding this easy to cope with. Best of luck!

  2. I found it very emotional, but strangely not as stressful. I guess my expectations about these possible experiences reduce the shock value.

    The seniors didn’t seem to feel anything; having done it for hundreds of times, the whole emotions probably fade away. I don’t know if that’s a skill I need to pick up though.

  3. Douja permalink

    The concept of some doctors slowly disconnecting from their seems uncanny. How some of them simply forget they are dealing with a person and not just a disease, I hope that you don’t have that moment ever, you seem like you are going to be one great doctor! If I ever need surgery, I think I could trust you 😛

  4. Well, I can’t blame them. Dealing with matters of daily life is stressful enough to most, how about dealing with death? The disconnect is probably more a defense mechanism than carelessness.

  5. Lana permalink

    Yeah, this is because you are just starting. Once you get you get used to it, you grow numb. And I think doctors should, (Well not just doctors, but anyone who has to deal with this kind of emotional stress), in order to be able to do their job. But I’m just wondering Ehab, how did you prepare yourself before actually practicing medicine? I mean you have to be a pretty grounded, calm person to do that, and not freak out. I’m just sayin’. 😛

  6. Lana,

    There is no intentional preparation involved. I guess that anybody can do it given the time to adjust.

  7. well u will get used to it soon …ask me 🙂 am working since 3 years at general ICU & we deal with these issues in a daily basis … this case you mentioned , a breast cancer patient who is probably having mets …doing intubation , sending to ICU , what will be the prognosis ?!!!a good doctor should asks this question to him/ her self !!!!! 45 min in an active CPR for an end stage CA with mets is too long in my opinion , especially a brain damage for sure occurred :S i guess that she lived for a couple of days , maybe weeks and then died after suffering more & more pain …..what you think ?!!

    • Orangee,

      Ya3teeki el 3afieh, at least there is a gift waiting for you as you go home: Great sleep! Nothing beats that 🙂

      What you said is true. And honestly, I still don’t know why the resident went on. He could have been hopeful, and he could have been just ignorant. He could have simply done it to avoid having to call the death with her family all waiting… There are many possible explanations.

      The whole social dynamic of practicing medicine (in a public hospital, especially) is something I’m coming to understand. The lack of trust in doctors, the possibility of being beaten by a patient’s family, etc all complicate the whole issue of what is medically right and wrong… I should probably write a separate post on that…

      You probably have some experiences in that regard, right?

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