I can't think of better way to deal with it other than share it with you.
She was Nice, a 43 y old women who just came to our city to visit her sister, enjoying her vacation. Other than flu or cold she was well managed on her medication. Actually her flight back to her home country was the next day, she thought that ER doctor will give her some pills then she can go to continue packing for travelling.
ER resident found that she is confuse, hypotensive (her blood pressure is low), and he notice some serious change in her routine investigation, he called me and ask for urgent review for this patient. I came and Cardiac resident came also, she had a rare autoimmune disease, type of Vasculitis (Churg Strauss syndrome), Bronchial Asthma and Congestive heart failure but both was somehow controlled with medication. We discussed her condition carefully and form a decent plan including admitting her in CCU (Cardiac care unite). Furthermore we both called consultants oncall to come and take a look. Cardiac and Internal medicine consultants agreed about the plan. After 4 hour she improved, i was there, she started to chat and even make some jokes and laugh, her only complain was she will miss her plain tomorrow. Her last investigation was fine, i checked them all, her vital singe (Blood pressure, pulse, temperature ,,etc) was normal, they called me for other patient so i left.
Doc your patient arrested
After less than half an hour, Code blue announced (it means patient arrested) central announced "code blue CCU". as a part of code blue team i went fast to CCU, in the way i was thinking that this can't be our new patient it must be other patient with acute condition like heart attack or something, when entered CCU, nurse said "Doc your patient arrested", i got choked, how come? i just left her in better condition. i reached her bed, a lot of doctors and nurses was there as part of code blue team and her medical care team. CPR (Cardiopulmonary resuscitation) started before we arrived, we toke over and continue according to policy. I was getting emotional, doing chest compression with extra effort, and hope that she will come back at any moment. We continue CPR for 30 minutes, we gave all recommended resuscitation medication, we was ready to give her DC shock if any cardiac activity came back but there was nothing. 30 minutes went fast. The hospital policy was that CPR should not be more than 30 minutes, nurse telling time is over, i hoped that i can continue but i know that wouldn't be helpful. Death declared after reexamining the patient and did some test.
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It is hard to accept unexpected sudden death
That is the worst part about working as health care provider, you have to accept your patient death and move on to take care of other patients. some doctors and nurses think that the treating consultant carry the heavy burden about anything happen to the patient. But i think nurses and resident doctors affected the most, they are more attached to the patient than any one else. For me with every patient loss i feel that i didn't do the best i could.
No matter how it all looks fine and that we covered every angle and follow the best guideline and evidence based medicine every time patient die i feel responsible to some extend. The idea of that we missed something never leave my mind for some time after she passed a way. i reviewed the file again and looked at everything. Couldn't find anything that we did wrong, but my doubts still there till the end of the day, finally here i am, writing about it for you, sharing this and knowing that someone reading is a relieve for me.
Thank you for reading this blog
Thank you for sharing that story.
Thank you for reading @lakshmi
It is difficult, trust and know you did all you could , we cannot know the future only the moment we are in. I lost my 55 year old husband suddenly and there was no explanation. He was put into medical coma and never woke up. So, difficult but, I made the decisions he expressed before the event happened and made peace with the knowledge I did what I knew was right in the moments. I am certain you did as well. May peace rest in your soul and calm your heart. It takes time.
I am sorry to hear that about your husband, i am glad you find your way to make peace with your self.
Really appreciate your nice words dear
Thanks a lot @steemyoga-1d
I can only imagine how hard that would be to deal with. I hope that sharing with us and knowing you have support here helps a little bit.
Yes in deed @kiwideb, telling the story was a relieve for me, my shift today was somehow fine.
Thanks a bunch for your comment dear.
By the way i am following you since a while
Really sorry that happened! We can't predict the future...if she was stable and you had others to care for, you did the right thing. It may have been a dysrhythmia that triggered it.
We will lose some, but to know how many you have saved hopefully will cheer you up!
I remember the first time I tried to do CPR on someone and just wanted to keep trying like you did.....They probably have that 30 minute rule because brain death is essentially occurred at that point. What I find fascinating is hypothermia and how long you can be resuscitated after that.
Again really sorry for what happened....keep being the good doctor the steem community knows you are!
Thank you @tfeldman, you are right it is unlikely for CPR to succeed if 30 minutes passed.
This patient had chest infection with adrenal insufficiency as she is known case of Eosinophilic polyangitits (Shurge Straus Syndrome) and on steroid, she didn't increase the dose with the new infection rather she missed some doses. But we corrected the metabolic acidosis nicely her ABG normalized and her Blood pressure was fine when i saw her before half an hour of arrest. She is also a known case of CHF but that was controlled and we was careful with re-hydration under Cardio team supervision. She is Asthmatic but chest was clear, no Wheezing and we didn't give any medication that could cause brochoconstrition.
Thank you fore commenting my friend, feels good to share this case with you
By the way Congrats for the new job, sorry to miss that, i had stessful 24 hour oncall, wish you the best Doc
Thank you! Wow, I have never seen eosinophilc polyangitis, but remember learning about it. I think I learned about it when studying the kidney....although, the cardiovascular effects are the most serious. If she was stable, there was nothing you would have done differently. Sorry that it happened.
Eosinophilic Granulomatosis with Polyangiitis is just a fancy new name for Churg Strauss Syndrome.
I think you are right, most likely the arrest from cardiac origin, her LVEF was 25%, which is DCMP by definition. No fluid overload for sure but as you said Arrhythmia is a possibility, actually most doctors accused cardiac arrhythmia for this arrest
It would be really hard for me to deal with that sort of thing. If something like that happened I would question myself and wonder if I could have done something more. Its an unfortunate experience, but it just goes to show you how limited our time is here.
You just expressed my feeling and thoughts. It is hard to accept that nothing can be done more, can't escape blaming my self after something like this happen even though every thing rationally looks fine. Eventually it will make you realize how your action is limited and you will accept it and move to work again after sometime.
Thank you for your comment @azfix
nice ~.~
Thank you @araki.
I come from China and have difficulty in expressing myself in English, but I try my best to make a comment here，because your words moved me so much.
I can feel your great respect for life, and maybe that is why you feel hard and painful to accept unexpected death.
Being a hero has its price. Sometimes it is a sense of frustration and powerlessness.
“Medicine is a science of uncertainty and an art of probability.” I think doctors can do much better than others in tolerating uncertainty, do you think so?