Aftermath

It was an afternoon like any other. They sat, in a circle, laughing. Carefree teases, mindless comments rung in the air. The sky seemed to agree with their joviality, clear and cloudless. Almost buried in their books & records, they seemed to have a resolute will to enjoy their youth. Looking at them, one would have been hard pressed to secern this bunch of students from any other.

They couldn’t be more wrong.
For, these were students of medicine.

And they were about to grow up, quite unexpectedly, in a span of an hour.

*

The wailing alarm startled them. “Code Blue!” came the screams.

With excited glances, they got up as one and rushed towards the ER, a mere metre away, eager to witness their first code blue.

And encountered chaos.

A man – a boy, really – was lying on the bed. It struck them all, in the instant they saw him, that he was younger than all of them. His body, lean and hard, suggested a familiarity with hard labour. In the quiet pandemonium they heard that he had fallen from a great height. Their fascinated eyes searched for blood, for signs of obvious trauma and found none. Rather than gore, it was the urgency in the air that alerted them. His face, startled and shocked with dilated eyes, was still for want of breath.

Nurses, calm and in haste, were loading the syringes. A doctor, with a face seemingly devoid of sentiment, searched for the radial pulse. Feeling none, his hands immediately rushed to the carotids. Chest compression had now become a necessity. The boy was under cardiac arrest. The doctor started resuscitation.
The students mutely counted – 30 compressions to 2 rescue breaths, as was the protocol. The anaesthetist ready with the endo-tracheal tube to intubate the patient, tilted the head, lifted the chin and thrust open the jaw. She pushed the tongue to a side and passed the tube in. The ventilator would do its job of perfusing the lungs – one less task to manage. The cardiologist & the physician took turns to administer compressions. Realising the gravity of the situation, they signaled the nurses to bring out the drugs. Wonder drugs, really. Adrenaline, being a vasopressor & a stimulant of the cardia was to increase the blood pressure. Atropine blocks the receptors on the heart to cause tachycardia.

*

They stood, silent. A little startled. Their books, their lessons till then had seemed surreal and distant. Safe & exotic. In a moment, it had come to life. They noticed another man standing in the sides, silent and forgotten by others. He would be the one who brought the boy to the hospital, they realised. The man’s face had a peculiar look, not unlike the one they themselves wore when a particularly hard lesson was going above their head.
Incomprehension.

Surely the man hadn’t expected this fatal turn of events… Was the boy’s laughter, heard just an hour before, still ringing in his head? Were the shared memories, a kinship born of hard labour, passing in front of the man’s eyes? Did he wonder, even as he watched his friend gasp for breath, of the words to be spoken to the boy’s family?

All of them had taken up medicine as a field of study, but none of them had thought of the fine intricacies that everyday practice would bring. None had bothered about the pathos linked to the promises of pride & accolades.
Now it stared at them. The inescapable, incurable pain and life of human emotions.

*

Spontaneous circulation had failed to return & ECG leads were connected. The sound of the machine recording the rhythm of the heart was loud enough to block the voices in the heads of the rescuers. There was a flicker of life when they realized that the patient had a shock-able rhythm. Two electrodes of the defibrillator were placed in position. A firm voice asked people to stand clear. A DC shock of 150 joules entered the body, trying to kick start the heart. The compressions were resumed, each second a treasure now. The ECG registered no change.
The drugs had failed. After what seemed like a forever 40 minutes, the people in white gave up hope.
The ECG was a flat-line.

*

So that was it. They saw the doctor shake his head a little as he called time, his visage no different than what it had been earlier.

The first death in front of their eyes, and it had occurred in a span of an hour. No tears. No sound. Only the silence of a continuous beep of the flat-line to herald the onset of death.

Every medical student goes through that one experience which gives them an understanding. An understanding of the enormity of their profession, of their responsibility. Of the consequences of their failure. And the god like power that they would one day possess. It is in that moment that youth is lost & a solemnity sets in. They will laugh, there will be moments of lightness. But they will never forget.

*

They trudged back from the ER, to their waiting books. None spoke, none thought. They were incapable of that. The buses came, each boarded their own & were greeted by friends with cheer. But that day they couldn’t smile & partake in the usual chatter on the journey home. Tomorrow would be another day, there would be another lesson to learn. Their experience was the first in the long file of highs & lows which would be part of their life from then on. Each realized it.

*

One of the gang was greeted by her mother with a smile when she reached home. It was then that some of the heaviness lifted.
From death to life, from a dramatic afternoon to a quiet evening. Her career was about to begin.

She was on her way to becoming a doctor.

*

P.S: This article was co-written with one of my oldest and dearest friend, Dr. Deepa. E
The idea to give small insight into what a doctor feels while fulfilling her professional duty and earning a wage is certainly not new. Without doubt, there are many accounts already in existence which are more elegantly expressed than ours.

However, this is a very personal attempt by a girl to document another very personal experience of a beloved friend. And for doctors like Deepa, these experiences are hardly abnormal. It was while she retold these stories to us that I realised – even the most simplest of medical procedures might sometimes demand a great deal from the person administering them.

To deal with death, with life – everyday.
What a gift they have, what a curse they live.