Chapter 1
It was 12:43 in the morning.
The scent of coffee was slowly covering the whole emergency room.
I watched the 4th year medical junior interns Stella and Miguel slowly make their way as they monitor the patients that looked codable.
My post-graduate intern Russel was barely hanging on. His eyes were closing, he then shakes it off trying to wake himself up as he was struggling to finish the death summary and death certificate of the patients we had tried to resuscitate earlier that day.
The emergency room was very busy.
The surgery department was struggling as patients were being wheeled in. The news was right, there was a car crash between a bus and other 2-3 cars. The casualties were numerous. The mortality and morbidity were rising.
The ENT department was starting to question every referral the surgery department was giving since the toxicity was rising.
I looked towards the OB department and I saw some of the other residents in a panic to get one of the women to the delivery room. I heard from one of the nurses she was at 8cm dilated and her bag of waters has finally broke. No matter how much the other residents tell the young woman not to push, she was pushing, pushing out her baby. You can see in her face her hardship, her desire to end that hardship once and for all.
I stood up and took off my coat, I looked towards my left and I saw Jane, my partner who was comfortably dozing off at the table. I gave her a small nudge.
She quickly woke up, with bloodshot eyes she looked at me.
I smiled at her and gave a small giggle
“Ina! Why did you wake me up? “Jane asked in confusion.
“People are watching,” I said simply. I got off the monoblock chair trying my best not to bother Russel.
“Doc!, Doc! “Stella came running towards our table
I looked at her blankly
“Doc! I can’t hear anything! I Cant hear a heartbeat! ” Stella said in all panic and horror in her eyes.
“Who? “I asked and I quickly took my stethoscope
Stella ran, “Patient Rica Laos ”
I followed her, I saw the relatives were already in anxiety, in confusion, her mother was starting to cry.
I made my way by asking them to step aside.
“Does she have any dentures? “I asked openly
“No “Her husband quickly responded
I placed my stethoscope on her chest. I placed my hand on her wrist. Then I finally decided to place my fingers at the carotid, none- there was nothing I could hear.
“Code! “I yelled on the top of my lungs
“Code”! I yelled once more I started to pump the chest of the patient, She was 47 years old, a female managed as a case of Hepatic Encephalopathy.
One of the nurses noticed me and started to yell code as well, My junior interns were now
Wearing gloves, the nurses assisted us as we wheeled the patient to the resuscitation area. They started to pump, One of the nurses yelled
“Epinephrine is given! ”
The nurses quickly gave me the ambubag. Miguel quickly took it from me and started hyperventilating as they were continuously resuscitating the patient. I reached for the intubating blade. I opened her mouth, I quickly pushed aside her tongue with the blade making sure I don’t break any of her teeth. I pushed through hoping to see her glottis. I finally saw it in view, I quickly pushed the endotracheal(ET) tube in, the nurse quickly inflated the balloon. Miguel quickly hooked the ambubag to the ET tube I placed my stethoscope on the chest
“Double bag “I instructed Miguel.
I listened to check if the ET tube was in place. I listened if it was in the stomach, I was certain it was in place. It was in the lungs.
“Doc, Rhythm check, ” One of the nurses said
I listened, no heartbeat, I checked for a pulse there was none
“Continue CPR! “I commanded
“Second Epinephrine! ” One of the nurses yelled out.
Russell Came rushing in looking in around how he could be of help.
“Facilitate the resuscitation, I ’ll talk to the relatives.
“Yes doc, “He said as he watched
I quickly headed towards the relatives.
The mother was going hysterical, her clenched fist was banging at her son in laws chest, everyone was trying to hold her down, Her son in law was staring blankly
“Maam and Sir, We are already at our second dose of epinephrine, if we reached the 5th dose of epinephrine and she would not be resuscitated that means that for 15 minutes her brain has no oxygen supply for already 15 minutes we could finally say that the patient was literally brain dead. If we resuscitate her then she would need to be hooked to a mechanical ventilator. We are still at risk since no oxygen supply to the brain can shut down other functions of the body. ”
“Doc! Please, Please! Please do whatever you could to save her “Her husband finally said.
I headed back to the resuscitation area. I looked at Russell
“How many epinephrine was already given? ” I asked
“We already had given the 4th dose doc, “Russel said as he was staring at his watch.
I headed back out.
“Maam and sir we are already at the 4th dose, one last dose and if she won’t be resuscitated she would be considered brain dead. “I said trying my best to look positive
I headed back
“Doc 5th dose given! ”
I looked at the relatives waiting for them to say something. We were at the 5th dose already.
“Doc! Stop! Stop! Please stop! “Her husband finally said
“Please stop! “He yelled at all of us.
I commanded “stop “.
Everyone stopped.
The nurses quickly gathered all the opened ampules, Miguel disconnected the ambubag and the ET tube.
Everyone started to move away.
The husband quickly came in the resuscitation area and took her in his arms.
He was wailing. I watched him, my heart was feeling heavy.
My heart felt a small tag.
Russel then deflated the balloon and finally pulled out the ET tube. Stella was hooked the ECG machine to finally take the last ECG reading.
I then headed towards her mother who was sitting at the floor, dumbfounded.
“Maam I am sorry for your loss, “I said with all sincerity.
She then hugged me tightly.
“I know you did what you could with my daughter, but I believe its better than we make her rest now. At least all the pain is gone and finally ended.
Stella handed me the ECG I starred at it.
There goes another soul, I thought to myself.
I slummed down on the monoblock chair. Jane was now awake and kicking writing down her final orders at the charts. I stare at my clock it was already 3 am. Everything felt so fast when you are in the Emergency room.
“I heard you had another one “Jane said as she gave a small giggle.
“Yeah “was the only thing I could answer. I finally felt how tired I was, how much I was wanting to sleep. How much energy was draining?
“I’ll just go to the comfort room, “I told to Jane
“Take your time, “She said as if she truly knew what I meant.
I looked inside making sure no one was around. I sat down at one of the toilets. Tears started to finally roll down my eyes. I did not know how to stop them.
This was my 8th code for the day and the 8th mortality. What will the other residents say? I will be forever questioned. This was unusual. No one codes this much, but why me?!
I hated it, I hated being known as TOXIC! Instead of bringing my patients home I have a habit of bringing them either to heaven or to hell.
I Cried, I cried hard. I wanted to bring back to life all those souls, but time was always against me.
To every loved one I’ve talked to, their eyes speak the truth, they are all asking me to tell them something positive, they are waiting for me to make them alive again, they are waiting for me to tell one more beautiful lie.
