Tuesday, 12 February 2008

Gossamer Thread

I was speaking to one of the other new anaesthetists the other day and we were discussing how the job was going. She said that we are now in the “danger period” in that we are good enough to be allowed to do things by ourselves and the consultants are happy enough for us to get on with our jobs without having to look over our shoulders the whole time. At the same time, we’re not good enough to be able to cope with every eventuality. The thing about anaesthetics is that when things go bad, they go VERY bad, VERY fast. I think what happened today just highlights this.

I was covering emergencies today and I get a call from one of the surgeons saying they want to operate on a patient from the Intensive Care Unit. When I go and see this woman, I find out that she is very sick indeed. She is in respiratory failure, kidney failure, she has septic shock and has just had a heart attack. The surgeons want to operate because they think her bowel has died.

The poor woman was on death’s door. I spoke with her and she realised that there was a good chance she may never wake up from my anaesthetic and she may die shortly after surgery.

“But what choice do I have doctor?” she rasps at me in a broad Irish accent. “It looks like I’m going to die anyway.”

It never seems to surprise me how some people can face their own mortality in such a calm and accepting manner. I concede that what she says is absolutely true. I give a terse smile and go down to prepare the operating theatres.

There was no way that I was going to anaesthetise this woman by myself. I know my limits. Yes, she’s clinging on to life by a gossamer thread. No, I’m not going to the person who cuts that thread and finally kills her. The ITU consultant, Dr Jones comes down with the patient and supervises me through the anaesthetic and the operation.

Mrs O’Kelly arrives in theatre and we get her on the operating table and I get ready to put her to sleep.

The last time I was in a situation like this, I coped. Things went well, the patient was alert and lucid after my anaesthetic and I went home feeling dead proud of myself.

This time, it was very different.

I’m not going to go into too many details, but Mrs O’Kelly very nearly died in front of me. I couldn’t cope. I could tell she was dying as well. She went from being pink to purple to blue to grey over about thirty seconds. The alarms on my anaesthetic machines were making all kinds of noises that I’d never heard before (and never want to hear again) and, I tried my hardest, I really did, but I couldn’t stop Mrs O’Kelly’s demise.

Dr Jones stepped in and took over and, thank God, she was able to rescue the situation.

I know that, had I been by myself, Mrs O’Kelly would be dead by now and that’s a horrible thought to have.

I love my job, I really do but at times like this I wonder if I’m really cut out for it. I’m not sure I could deal with people nearly dying in front of me every time I go on call. I think the pressure would get to me eventually. One of the theatre nurses once told me, "Michael, you worry too much" and I think he is probably right.

At this stage in my career, I can’t help but feel that sooner or later, somebody is actually going to die and it’ll be all my fault. I really don’t think I could cope with that. I’m not sure I could deal with that feeling.

I don’t think I’m that strong.


Jo said...

{lots of hugs}
The fact that you care so much says to me that should someone die on your shift, it is not going to be your fault - you are going to do everything that you can to save them.

the little medic said...

You can only do your best, sometimes that just won't be good enough and some people will die. It certainly isn't your fault - i'm sure you do everything you can to try and save them. The ones you lose - its just their time.

Experience is the only way to 'learn' things like that.

Anonymous said...

At this stage in my career, I can’t help but feel that sooner or later, somebody is actually going to die and it’ll be all 'my fault.'

I don't think so doctor, it won't be you fault given that you will do your best every time and call for help when needed. You are like that IMO. But, people will die because this is part of life and of medicine of course.

Everytime this happens, remember that death too can be a blessing, especially at the end of prolonged suffering. So, everytime a patient dies, say to yourself that you have done your best, several times. This should help you cope. You also build more and more confidence with time and expertise so, in time and with practise you will not be or look so worried infront of other staff.

steph said...

A moving post. I'm humbled that you shared it here - thank you!

And I'm a great believer in wake-up calls to remind us of the privileges we so often take for granted.

Anonymous said...

I'm not a medic -- just yer average lay person who has watched too many people who are close to her die in hospital. All I can say is thank God you give a shit -- not everyone in your line of work does. You should be proud of feelng as you do, and that you haven't yet become hardened to it all. And the only way you, or anyone else, will get better is through grim experience, I'm afraid -- we, the great unwashed out here, really need you to grit your teeth and learn -- even if you do finish a few of us off in the meantime. Please keep at it!