As Doctors’ Day is being observed on July 1, my mind and heart are with a patient whose treatment I was recently involved in. Recently, I started my morning rounds in the ICU with a 21-year old youth who had just been operated on. He was admitted following an accident involving his two-wheeler, which had crashed against a wall in the wee hours.
Investigation suggested life-threatening abdominal injury. He was clinically unstable even as surgery commenced. His liver had avulsed off a large vein, the IVC, causing about 6 litres of blood to pool in his abdomen. Gross hypotension (low blood pressure) led to cardiac arrest on the operating table, from which he was resuscitated. He was on a ventilator in the ICU. Persistent hypotension led to one setback after another.
His kidneys failed. Hypotension necessitated transfusion of large volumes of blood and intravenous fluids, which caused fluid to accumulate in his lungs as his failed kidneys were unable to excrete the fluid being pumped into him. Oxygen levels in his blood dipped. The only option was dialysis to get rid of the excess fluid, which was precluded due to hypotension and coagulopathy (a condition in which blood doesn’t clot).
With every passing minute, the chances of recovery seemed remote, much to the disappointment of the treating team, who wanted the 21-year-old to somehow survive. Unable to surmount too many odds against him, the youth passed away in the afternoon. His mother’s wailing in the corridor outside broke our hearts. We had lost a well-fought battle.
The treating team was not dealing with a wrecked automobile, but a human body, which is a complicated assembly of well-coordinated organs that are interdependent and follow a natural path of clinical deterioration or improvement barely under the control of the treating personnel. These facts must be remembered by the irate public who pick up cudgels against healthcare providers.
The family of this youth accepted his passing with heavy heart, as it had witnessed the battle healthcare givers had waged to save his life, though in vain. When we removed the blood-soaked gloves from our sweaty hands to comfort the grieving family, we felt the pain of losing a 21-year-old at the dawn of his life as our personal loss.