Life-and-Death

I stood silent, motionless, unfocused. Every breath felt like an explosion within the lungs and every muscle heavy. It was 6:30 in the morning, and I was trying to call the senior doctor. I had to inform him about a sudden breathlessness in a patient.

I was an intern in the medical wards and I had to do the night shift.

After finishing the evening rounds, I stayed up late to record the vitals and findings in the patients' case sheets. The anxiety about staying up late in the night and monitoring the patients was already consumed as I was now a couple of days into the night shifts; I was a pro at checking the BP and auscultating for air entry into the lungs. I needed seconds to assess the patients' air entry even in the noisiest of situations. But, this time it was different: I couldn't understand what was happening.

The patient previously had bullae in his lung and if it ruptured, there might be no intervention left. And here I was, standing in front of the same patient, breathless, watching him with my sleepless eyes and trying to comprehend the vitals in the pulse-oximeter. The saturation was 87%, the heart was beating 150 times a minute and his respiration was shallow and fast, very fast. We had to do something, just anything, but something. I telephoned the senior doctor.

Every second felt like an hour and every ring felt closer to the oblivion. So anxious, I was forgetting what I needed to inform. I restlessly waited for him to pick up.

The patient's wife was standing next to him. Any sudden gestures from us would startle her. Not that she wasn't already

apprehensive and crying–but I didn't want to inflict more apprehension.

This was the first time I was supposed to be capable of handling an emergency. But, more importantly–this was the first time I was *expected* to handle it *alone*.

At that moment, my world was split into two and my mind obliterated. This is the profession I dreamed of. But, is this the profession I am suited for? Am I incapable? Will I ever be capable enough? Will I save this patient and will I be able to live with it if I don't? Should I run or should I stay? Should I scream at the consultant for not responding quickly or should I presume that he might be in some other emergency all by himself and keep my arguments to myself? Do all doctors go through this *training'*? Do all doctors pass this training?

The questions rushed through my mind, stampeding the response needed for the situation.

On the phone, I hear a voice from the other side. All these thoughts vanished and I spoke to him precisely what I needed to convey. He said “Shift to ICU. You can't handle this. Explain to his wife that he might not survive this emergency.” and put the phone down.

Grasping the sternness in his tone, I decided to go against the will to call him again and ask if he could come. Instructing the nurses to follow the orders, I brisked into the ward. Sobbing in a corner, left unconsoled, unexplained, uncared, his wife's eyes were screaming "I'm afraid! Please help me. I don't want to lose him." I approached her and I didn't know what face to put. A weak smile? a concerned face? a sad face? should I sob with her? I didn't know. I still don't know. I nevertheless explained her the situation. I told her what his vitals indicate. Then the toughest part came. Conveying the "he might not survive this emergency" part–the elephant in the ward.

I make an emotionless face and utter the words as they came. "He may not survive this emergency." There it was. I said it. I was relieved that I conveyed. But, soon, the relief turned into a self-hatred. I played my part of the script. But, how will she? She doesn't have a script. This is a first-time situation for her too. She didn't know what emotions to show and what to hide. She was blank but tears rolled down her eyes. That communicated what she wanted to say. There was nobody to wipe her tears, she had to do it herself. I stood there till she cleared up and gave her consent to shift to ICU.

We hurried to the ICU and the patient was intubated soon. His vitals stabilized. It was time for me to leave. I left the hospital. While leaving, I left the fear I had. But, I sure did bring the courage, compassion and the experience with me. This was a life-changing experience. I went home as I had another night shift the next day.

When I came back the next day, he wasn't there. I ask the nurse, she said “Doctor advised a few more days of observation, but his family declined and took him home. He might not survive."