The day began like any other day – I got up, was running late, but managed to get to morning report just in time. Then, 10 minutes into the report, one of the attendings got a phone call and interrupted the resident who was presenting with, “There’s a resuscitation on the ward.” Prema and one of the medical officers got up to go, and I hurried after them, dumping the contents of my bookbag on the floor in the process of pulling out my stethoscope.
I have been dreading this for the entire time I’ve been here, though I had thought that it would have happened sooner, with the high acuity of the patients and the lack of basic equipment. I also had a morbid curiosity, though, about how a resuscitation would be run in the middle of the ward, since there are so many other parents and children in the same room. The answer is: it’s pretty much run in the middle of the ward. There were some dividers on wheels positioned around the bed, but you could still see 10 people crowded behind them, and hear every word that they were saying. And the dividers didn’t extend all the way to the head of the bed, where Changi was bagging the child. It was eerily quiet, as all the parents looked on in horror or tried to shield their children’s eyes.
Part of my interest was purely for myself – I’ve known the whole time that I’ve been here that the true test of whether or not I want to go into pediatric critical care is whether or not I can handle the death of a patient. We lost a patient last week, but I wasn’t there to see it happen, so in a lot of ways it was still pretty remote. The baby was there one day, and not the next. But this was very, very real – compressions, alarms on the monitor, medicine bottles, discarded gloves and syringes. There was a debate about whether or not to intubate the child, because it was a case of TB meningitis, and there is no isolation ward for children. TB is usually not a problem in kids, because they can’t work up the strength to cough out any infected droplets/sputum; intubating them just opens all of that up to the world. The decision was made not to intubate, and within 5 minutes, it was over. Time of death was called at 7:50 am.
To be honest, it all felt pretty surreal. I didn’t really take part in the resuscitation, because there were already enough people. I kind of hung around on the edges, then walked back to morning report with Prema. I couldn’t tell which of the mothers was the child’s, if she was there at all. But overall, I felt the same as I have when I’ve seen other patients pass in the ER – it’s a tragedy, especially for a child, but it also is a relief to their suffering. You hope that they’re in a better place.
I passed the rest of the day in clinic, where I can pretty much zone out anyway. A lot of these kids are absolutely beautiful, and incredibly adorable, and I wanted to take them all home. We had a few cancellations, so Dr. Kung spent the down time quizzing Dr. David, one of the second year residents who’s doing a sub-specialty rotation this month and is shadowing Dr. Kung with me in the clinic. Dr. Kung gives balloons and stickers to every patient, and the last patient was a super-cute little boy who discovered that dropping his balloon and making Dr. David pick it up was a really fun game. I was also endlessly entertained.
Entered some charts in the afternoon, and avoided the wards for the rest of the day.
I was cranky and hormonal when I got home, and maybe I was more affected than I realized by the morning's events, because I nearly set the dorm on fire after putting olive oil in a pan to heat on the stove and forgetting about it. Good job me. Went to bed early.
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