There was once a time where a headache was treated by drilling into the skull and a cure for jaundice was swallowing nine lice mixed with ale (aka a Wetherspoon’s IPA).
Since then, medicine has come a long way. We can now stop a beating heart, operate, and then bring the patient back from technically being “dead”. We can take a patient from frank, severe psychosis and nurture them back into society. We can even have a stab at global pandemics.
Sometimes, I read a patient’s notes (or even experience first-hand) the methods we have developed in medicine to improve symptoms and extend lives. As a member of a research-heavy university, I’m also exposed to the pioneering studies and innovations pushing science and healthcare forward. It’s all rather exciting, and I’m happy to be a part of it.
But sometimes, it’s just not enough.
On my A+E placement*, on the same shift I saw two extremes of modern medicine: one patient who was yanked back from the brink and another for whom nothing, absolutely nothing, could be done. The fact these happened on the same shift made it a natural point of comparison and reflection, so I’d like to share that with you today.
*I’m currently on my GP placement but wanted to allow some time to elapse before discussing these cases, due to confidentiality.
My first cardiac arrest
I really enjoyed my immediate life support training; it was engaging, informative and I genuinely felt semi-competent. The next day, I was helping at a cardiac arrest. Thank f*ck I paid attention.
A cardiac arrest essentially means a patient’s heart has stopped, or is in a rhythm that is not compatible with life- in other words, if nothing is done then their heart will not be able to function enough to pump blood around the body, including to the brain. This patient had luckily collapsed just outside A+E, so everything could be done very speedily.
The patient was wheeled very quickly into the resuscitation bay, surrounded by healthcare professionals and having repeated chest compressions (aka CPR). The image of a cardiac arrest on TV and in films is very characteristic:
- Everyone panics, alarms go off and dramatic music plays
- Attractive nurse yells for a doctor
- Attractive doctor screams “I’M NOT GIVING UP” whilst simultaneously giving very poor-quality CPR
- Everyone continues to panic and The Fray plays in the background
- Attractive doctor yells “CLEAR” and attractively defibrillates the patient
- Dramatic seconds pass with a pregnant pause that gives birth to a patient opening their eyes
- Everyone sighs and then it cuts to the side story involving a patient-doctor relationship, both attractive
It may interest you to know that this is far from the reality. It may, on the surface, seem like an uncoordinated mess but the truth is a cardiac arrest is managed with a very strict set of protocols. Everyone involved knows the process, there is clear communication and the patient is supported in a logical, systematic fashion. The messy appearance comes from the sheer number of people who need to be involved, the time-sensitive nature and the fact that there is no dignified way to give good CPR.
Being involved in a cardiac arrest was a moment of personal significance for me. As a medical student, we are rarely useful in an actual emergency but helping with the patient and documenting the drugs given were both important tasks, and I felt comfortable doing them.
Eventually, the patient had “ROSC” (return of spontaneous circulation, aka their heart was back in a normal rhythm and a pulse could be felt) and they quickly perked up. I spent some time talking to the patient and their emotional daughter, trying not to smile too much whilst telling them what had happened. After all, medicine may detach us from distressing situations but we need to be careful not to act insensitively!
The limits of medicine
Later on in the shift, a patient was wheeled in unconscious, under anaesthetic. The story was they were at home when they collapsed and were unrousable. The team suspected a bleed in the brain, given the patient’s age and history.
Everything moved quickly from there: the patient was investigated and indeed, had suffered a catastrophic brain bleed. They were not responsive, requiring more and more physiological support and there was no indication of any breathing effort alongside the ventilator.
Nothing could be done. One minute, the patient was alive, possibly making a cup of tea or dreaming up a grand idea. The next minute, they were unconscious. Aside from supporting the patient’s bodily functions, modern medicine had nothing to offer. No cure, no surgery, no magic bullet.
The patient’s family came to say goodbye later and, in a very different way, this was also a moment of personal significance for me. Hearing about the patient’s life, their personality, their stories from the ones who loved them the most was as rewarding as it was devastating. I consider myself a fairly stoic individual but that moment was a challenge for me to stay professional.
Two patients, two different outcomes. It really is the stuff of film and TV. But what the fictional stories don’t communicate is the raw emotion and guilt you feel for a patient who has reached the end of what can be done. For some patients, we can perform “miracles”, for others we can’t even give them an extra few minutes of talking, listening, loving.
One thing this shift did do was affirm my desire to keep going in medicine. Ultimately, the extremes of medicine will rear their heads every so often but, when they do, I’d consider myself lucky to be the one unlucky enough to greet them.
Hardeep Lotay 