6 o’clock on a weekend evening. A sunny day was setting in the peak summers. Although, I was in a rural area posted as a Medical Officer, weekend still carries a vibe where you tend to relax. That’s what I was doing. Listening to some soft music in room… my definition of relaxing. And just as I started humming the chorus line, the phone rang!
“Sir, a guy has been brought in unconscious state, his pulse is 86 and saturation is ok but he is not responding,” said the medical assistant. “Take Blood Pressure, I am Coming…” I responded in a slightly vexed manner; my chorus line was left incomplete.
Making way to the examination room which was hardly 100 metres from my residence, I started working out the possibilities… I guess it’s a little something your brain starts doing when you are the sole medical authority in vicinity of 100 kilometres. Having spent close to three years here, most of the patients who came in unconscious were usually postictal state, hypoglycaemia, dehydration; I mean- manageable and not strictly an emergency. And here I knew the guy was still alive, how bad could it be.
“Sir, the BP is 180/120,” exclaimed the nervous assistant as I entered the room. No eye opening, No verbal response but the individual was moving his limbs in response to painful stimuli. That was some saving grace. Immediately taking out my pen torch, I went on to check the pupils. Left pupil was mid dilated with no reaction. My worst fears had been realised and I was in for a rollercoaster weekend ahead.
As a doctor, you always dream of handling an emergency in the swiftest way, saving the day and becoming a hero. Yet when you face it, you wish your suspicion and diagnosis be wrong, and everyone just makes it out alive! That is the only thought that ran across my mind that moment.
My subconscious continuing the deductions reached a conclusion that it had to be an internal bleed in the brain. “Get Mannitol… and a laryngoscope… and an Endotracheal tube…” I asked the assistant, trying to recollect if anything else was required. “ And look for labetalol if we have,” shouting again as he rushed towards emergency equipment trolley. After starting mannitol and lasix (that’s how close I got to an emergency antihypertensive), I tried intubating but the patient resisted. Guess, he was not that unconscious.
Time was crucial. Without wasting much time, I went outside and gazed at the sky. I wish praying helped but I was checking out the weather for possibility of air evacuation. Yes, we had a helipad and a helicopter would come for medical emergency.
Nonetheless, even the Gods had plans on their Sabbath, I presume… Gods of Mischief and Death to be precise. The beautiful sunny day it had been, was now windy and cloudy and I stood aghast. The closest tertiary care hospital was two hours away if the traffic permitted. “Does he have that much time…” I thought to myself. “Load him up in the ambulance, we will move by road,” I yelled, realising the lack of options.
My medical assistant would take me as a spiritual Guru that day, as I mumbled all the religious shlokas and mantras I could remember while accompanying him to the hospital. There was nothing else we could do. Just wish for that artery to bleed a little slow maybe…
As luck would have it, we made it in time. The guy was found to have a malignant infarct which continued to expand and compress his brain. He underwent an emergency decompressive craniotomy and was on ventilator for three days. Gradually he survived that and started improving.
Me and my team got heaps of praises from all around. Timely action and intervention had proved to be life saving, and that is all that mattered. You realise that medical profession is not defined by prescribing antibiotics or painkillers, it is defined by the lives you save, that is where the nobility of the profession lies. I felt so satisfied having spoilt the weekend of the God of Death… or Did I?
Two weeks into the incident as I sat in my office, my cellphone pings-a WhatsApp message. It was an image of some medical document my medical assistant had sent. It was a normal affair, he would send me some medical documents of patients for opinion. But this one was a death certificate. My eyes caught the bold letters mentioning the condition directly leading to death- LT MCA MALIGNANT INFARCT, POST DECOMPRESSIVE CRANIOTOMY. I didn’t want to read the name. I hoped it was not him… how could it be, he was out of danger. And then the second message dropped- Sir, he had sudden heart attack today morning and passed away.
We had no role in whatever had happened to him in the hospital nonetheless, this felt as a loss, a very personal loss… not just to me, to my whole team. We were dejected. Every tragic ending- Gods have the final laugh and humans just blame it on destiny.
We very often hear it in our profession, “We heal He cures.” Quite the spiritual twist in a scientific job, which we tend to ignore credulously. Whether this river of life swells up or dries down, might not be in our control, the medical profession definitely holds the potential to change the course of the flow… even if it is for a short while!
Howbeit, He does make you realise every now and then, that if life is an art, He is the artist and we are mere instruments… of His weekend plans sometimes.
