Mar 20, 2015

    Lessons from a dead patient

    I WAS 20 then. It was just a few months before graduation, when I would have become a full-fledged adult with a bachelor's degree in nursing. But for the moment I was focusing on being a good student nurse.

    It was the first day of our clinical duty at the emergency room. We were on the morning shift, so we had a busy start.


    One of my assigned patients was a young male, just a few years shy of 30 and diagnosed with meningitis.

    He was one of the many patients I tended in the four years of my student-nurse days. But I remember him so well, and I do not think I will ever forget him.

    When I first saw him, it was as if he were in the intensive care unit: numerous attachments on his body, intravenous fluid dripping rapidly into a vein in his left hand, an endotracheal tube and whatnot.

    But the fact was he was in the emergency room, his gurney tightly squeezed beside another gurney, in the far corner, as if he had just come in and been assigned a tiny space until a private room became vacant. It turned out, however, that he had been in the hospital for more than three days. There was no room or ward space available for him.

    I elbowed my way to his gurney to take his initial vital signs for the shift. He was warm - too warm - and was struggling to breathe. I noticed a number of small dark marks on his face, arms and chest; I suspected chicken pox, but I did not ask. He could barely move; only his eyes moved when I talked to him.

    I loved talking to my patients, including this one. It meant giving him a nice, soothing affirmation that he would be okay, that I would be there to take care of him and that, if he needed anything, I would be there from 6am to 2pm. His SOs - significant others - looked at me tentatively, giving me a weak smile.

    "I don't think he'll be okay," the woman said. I thought she was his mother.

    "We brought him in early this week, when his fever was so high. It was only chicken pox. The doctor said the virus had reached his brain."

    I nodded. My suspicions were proven correct. "I'm his aunt, by the way," the woman continued. The man beside her was silent, his eyes cast down to the white tiled floor, seemingly in deep thought.

    "He's his brother," she said, indicating the man beside her.

    "His temperature is at 40 degrees right now, ma'am. I'll get some water to give him a sponge bath," I offered.

    "It's okay," the aunt said. "I don't think it'll work. He's…" And then she stopped talking as her gaze fell on the patient. "It's fine, ma'am. I'll do it for you. It may help," I said.

    I smiled at her and asked to be excused. I had other patients to see.


    Hours passed. I had a rough day: catheters, electrocardiograms, IVTT medication, tepid sponge baths, and hourly taking of vital signs.

    But my day was set to become busier. I returned to my chicken-pox-turned-meningitis patient to take his vital signs again, and to check if his fever had subsided.

    "Hello, sir. I'm here again," I said to my patient even though I knew he couldn't answer me. But his eyes darted towards my direction, as if to confirm that he had heard me.

    I proceeded to check his temperature while counting his respiratory and pulse rates - an old trick to save time, as well as to keep the patient from being too conscious that I am counting his breaths. After checking his respiratory rate, I checked his radial pulse - the inside of the wrist - but the pulse was too weak, almost as if there was nothing there.

    I checked his carotid pulse - the side of the neck - but there was none. I told myself I would check again later, when I was done with taking his blood pressure. But as I took his blood pressure, I heard nothing - no systolic or diastolic tick.

    The aunt looked at me. Perhaps the worry was showing on my face.

    "Is he gone?" she asked nervously.

    I could not tell her. We student nurses have no right to tell the significant others; that is the doctor's duty. I called my colleague to watch over my patient while I went to get a doctor.

    The doctor checked my patient's heartbeat and pulse. Then he performed cardiopulmonary resuscitation. Re-checked. By the look on his face, I could tell. There was nothing. No pulse, no breathing.

    "I'm sorry, ma'am, but the patient is gone. We did our best," the doctor told the aunt.

    The brother cried silently, the aunt sobbed. I gave her a nod of sympathy and proceeded to unhook the patient's tubes. That done, I took him to the back of the emergency room for post-mortem care.

    He had died in my arms. I was probably the last person he saw before drifting away, and that is something I just cannot brush off from my memory.


    My patient, the first corpse I have ever touched in my life - the first and last so far - taught me a lot as I think about my life now; now that I am an adult with a job and a life of my own; now as I battle depression and suicidal thoughts.

    He taught me that life can be taken from you at any time, whether you are young or old, whether you have cancer or chicken pox. He taught me that Death is like a thief in the night, just lurking in the corner while you live as you must, and then in one moment, seizes you and wrings you dry until you are lifeless.

    He taught me that Death will come to you when your time on earth has come. It will come whatever you are doing, however successful or hopeless you are, because Death is a blind bastard that just takes you effortlessly, as if he were your real owner and Life had just borrowed you.

    My dear patient, wherever you are, may you be at rest. Thank you for sharing your life with me, even for only a few hours, and for trusting me to be with you as you crossed over. I will always remember you.


    The writer, a registered nurse, is a marketing copywriter for an Internet software development company. She practised nursing for a few months before switching professions.