Not just another day at work..

It is inevitable as a doctor to come face to face with death. I wish I could say I remember vividly how I felt when I handled my first death case but I can't. All those deaths that happened in my years of working have intermingled with each other and have become as blurry as the emotions that I feel whenever another life is terminated. However, there are a few that has stayed as clear as if it happened just yesterday.

I was on call on the male side that night. What that means is that there is a near to nil chance of sleeping and almost 98% chance of doing a peritoneal dialysis (PD). I don't know what it is like in other hospitals but in HRPZII, doing a PD is as routine as taking your patient's blood. The first thing a freshie houseman has to learn from his or her senior HO is how to do a PD. It is not unusual to walk into the male ward and see 5 beds in a row with PD dialysate hanging from drip stands.

The patient was placed in the first bed on the left of the ward. He was about 35, and with skin as yellow as anything. I don't know why he was in, I only know that I was supposed to do a PD on him that night. As far as I remember, I followed each step of it by the book and the patient wasn't even in the list of high risk candidates for perforation - introduction of the troca was relatively easy I didn't need to redo it.

The next thing I know, the patient's body convulsed and after a few moments, lay still. I alerted my MO and started CPR but couldn't revive him.

I don't remember what my MO put down as the cause of death but I do remember seeing the faces of his wife and relatives and hearing the wail of his toddler kid. They say kids can see the angel of death coming to do his job. They had come to visit him - ill but at least alive - instead had to return home with a lifeless body.

Yes I was devastated but I didn't have time to dwell on it. Being a houseman means a death is just another day at work. You have to be detached emotionally. I guess I was lucky in the sense that I posessed that detachment and saw all the deaths that happened as just another learning experience.

Yet, despite it happening about 5 years ago I keep soming back to that night and wondering whether it was something I did that resulted in his demise.

There were numerous other deaths - the kid with CP, the many many retroviral patients, my ESRF makcik who spent months in the ward and died alone, the diabetic with gas gangrene who refused amputation until it was too late and died of sepsis. Despite being so blase about it all, you just have to take a moment to remind yourself that even though he/she was just another number on your mortality statistic, he/she was someone's mother/father/sister/brother/wife/husband and to the family, their deaths isn't JUST another day at work.