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Chest Compressions

First year MBBS:

Some doctors from Anaesthesia department come to our class. I mean seriously, proffs are round the corner and they want to teach us about something called CPR now? I mean I know what it is,

CHEST COMPRESSIONS!


Yeah, got it.


But seriously, do we really need to waste time on this right now? I mean who is dying already? We are not even doctors yet.


When will this end?


Internship Year:

Some Day of January, 2020.

5:00 pm

It is my medicine rotation and I want this to be over already. I have taken all the vitals, done the sampling for the day and practically everything that needed to be done. Why exactly am I still sitting in this ward then? I might as well have some chai and Marie Gold.


6:00 pm

*Co-intern calling..*

“Pavitraaaaaaa, COME FAST!”

“WHAT HAPPENED? I HAVE JUST COME FOR CHAI!”

“BOLA NA! COME ASAP”


--CALL ENDED—


6:10 pm

The same ‘Male Medical Ward’.

But wait,

a different atmosphere.


As I enter that ward for like the 500th time, it just doesn’t look the same. All the nurses are in quick action, getting IV sets and ET tubes, a PG, however of another unit and my co intern all gathered around….


Wait, WHAT? DAMODAR?


Damodar Mandal,a thirty year old type 1 diabetes mellitus patient with bed sores which are the worst I have ever seen before. The patient who is thin as a stick, depressed (I guess), never sits, never laughs, never cries (at least visibly) but always asks, “Madam sugar controlled hai?”


His mother, ‘Damodar ki Amma’ as we know her, is old, poor, has only two sarees but is hopeful, cheerful, loves the sun and well, right now is crying.


I remember the last contact I had with Damodar, his sugar was 156 mg/dl.

By God’s grace, not hypo/hyperglycemic.


And now, here he was.


Eyes rolled up. Pallor spread across his face, he has never looked sicker even though he is the sickest.

With an AMBU bag on his face and my co intern on his bed giving chest compressions. The male nurse ready with an ET tube and female nurse with a suction catheter. A whole lot of equipment near his bed.


Strangely, in this moment, for a fraction of a second I look at the staffs’ faces. Even though we all know this can be the time when Damodar leaves us, forever; they are still calm and composed while being in a hurry at the same time.


How is it possible?


The next second, my co-intern looks at me and we both sigh.


And the one next to that, the PG says, “Pavitraa, iska ABG karke laa.”

So yes, I get the ABG syringe heparinised and am ready to take the sample.


Have I done this before? Yes.

Are my hands still trembling while doing this? Also, yes.


So, the PG takes the syringe from me, signaling me to continue bag and mask ventilation .

When the blood sample is taken, he asks me to do chest compressions.


In that very second, that day of first year comes rushing back to my mind.

That day if I would have tried chest compressions on the dummy, would this be easier?


I think I must have gone pale in this one second.

My co intern quietly said, “Breathe and just get this ABG report.”

Well, this I could do.


Now, working in an under sourced hospital like SSKH means anything can stop working at any point of time. This time, it is the ABG machine near the male ward.

So the next option?

Run to the ground floor, to a centre near emergency and get the report ASAP.

So here comes my super hero moment. “This boy cannot die”, I say to myself.


And so I run.

I run frantically.

I run faster than I thought I could anymore.


Getting the sample processed and the report in my hand, I reach the ward in ten minutes.

I am hoping, okay praying all the way that I reach on time.

I knew the ABG isn’t the most important thing here but seriously, what if it is? What if a BiPAP can save Damodar Mandal?


As I enter, Damodar’s Amma is crying louder, I think my heart skipped a beat.

But to my relief, the CPR is still happening. There is still hope. We still can get Damodar back.


So yes, what follows is approximately the fastest thirty minutes of my life.

I do it all in these minutes.

Bag and mask ventilation, IV cannulation, suctioning and well, chest compressions, just how they should be done.


In the last few minutes, we are starting to lose hope.

The CPCR doesn’t seem to work.

The ECG still shows flat lines, the ones I have seen only in TV shows and movies.

Three more attempts to go before we settle on the decision that Damodar is no more.


I am visibly tired and so other people replace me for doing chest compressions. I am now standing at some distance from the bed. I can be a spectator till the time we need more suctioning……..

.

..

The third attempt is over. We know it now.


The ECG shows a flat line.


I am standing near the ECG machine and the nurse says, “Press the print button.”

And so I do.

What comes out on those grids is something that makes me go numb.


An ECG with just flat lines.


My heart sinks.


The doctors remove their gloves and masks. The nursing staff removes all the equipment and the helpers get ready to cover the “body” which was, Damodar.

I too remove my mask and gloves, dispose them and rush to the washroom.


Once inside, I burst into tears. I cannot make a noise because I am a doctor now. I m supposed to be strong and not emotional.


I cry badly.


But the thing is, I cannot even cry for long.

I somehow wipe those tears and come out.


All patients looking at me, knowing that the intern who troubles them every day by pricking them with needles and takes out more blood than they think they have for investigations, is in fact not a blood sucking machine.


I run from there after informing my co intern who seems to have taken this situation much better than me, clearly.


After some more minutes of crying, I return to the ward. I know I have two more hours to spend in this ward.


Everything seems normal again.


Everyone is doing their work as if nothing happened.


I bring up the courage to look at Damodar’s bed one last time, where there would be someone else tomorrow.


I do not remember what his face looked like when I printed that ECG.


But now, there are curtains all over that bed.

Damodar’s body is wrapped in a cloth. Rather, tied.

Amma is now crying louder than ever.

Damodar ke papa is here but numb.


And Damodar?

Well his sugar is controlled, wherever he is.

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