Wednesday, January 27, 2010

The circle of life.

As one life began around 1915 today in OR 3, another life in the very next room was ending. A woman I spoke to last night about her extensive wound to her left leg died today. Her death was especially hard because today she finally agreed to the surgery after refusing to have her leg amputated for several days.

Today was actually my first day in the operating room due to the departure on a pedi anesthesiologist and a nurse anesthetist. Most of our general cases are done with ketamine & versed because oxygen is in very short supply, and the only working anesthesia machine is in OR one, which also happens to have an EKG monitor. So in OR's two, three, and four our only monitors are a blood pressure machine and a portable sat monitor, which are difficult to use because patients are often cold or we are amputing the one extremity where we can pick up a sat (no ear probes available).

According to the anesthesiologist doing her case, they had just ligated the sciatic nerve when he got a low blood pressure reading. A short time later he lost her sat reading. He checked a carotid pulse and found she had none. At this point they started chest compressions and began to bag mask her with room air.

I was next door and had just finished helping the nurse anesthetist put in a spinal on a woman having a caesarian section, when Dr. Garcia bursts through the door in search of oxygen. Thinking our 19 year old in the ICU was decompensating again I was surprised when he said the patient next door was "in trouble."

I rushed next door find the orthopedic surgeon on a stool performing chest compressions and began administering cardiac resuscitative drugs. Epinephrine and atropine were in no short supply. We even had amps of calcium and plenty of lidocaine. Chest compressions to circulate the epi were sufficient enough to generate systolic pressures in the 70's and diastolic pressures in the 40's at one point, but to no avail. We had to call it. Time of death: 19:35.

There was no sustained drone of a flatline like on tv, for we had no EKG monitor in this room. There was only the deafening silence of our profound sense of sadness that not everyone we lay on our operating table will rise again. Given the acute demise of our patient I suspected she suffered a massive pulmonary embolism due to a blood clot that very likely would have developed in her badly fractured leg. As we began the work of sewing her leg back together and cleaning her up for her family, we each went to that objective place we all go that allows to cope with the extent of the loss of life and limb. But for one of us, a general surgical intern who was first assist in the case and one of the wound care team members who encouraged her to have the amputation, the day's stresses proved to be too overwhelming, and the woman's death took him to his emotional breaking point. We allowed him to shed tears for all of us, as this particular death--the first intraoperative death at our hospital--is undoubtedly poignantly and indelibly etched on the tableau of our experience here in Haiti.

1 comment:

  1. When the mother of the unnamed baby boy in this picture was moved from post op to post partum, the first thing she noticed in the area were the cracks in the wall. I honestly believed it was just the paint peeling from the wall (I had seen other buildings with true cracks), but the mother was unconvinced, and she burst into tears. She wanted to leave, even though she could barely walk. It took an hour of me wiping her tears and talking in my broken creole/french/english mish mash to convince her to stay. PTSD is real, and we must not overllok the role it plays in the recovery of our patients.