Experience

It was a Thursday.

I was on duty as junior resident in charge of the trauma ward. A ward full of very sick patients. Amazing how much responsibility they thrust on the most inexperienced member of the team. But that’s just the way it's always been.

He came in GCS 3. Basically breathing not doing anything much else. A middle aged man involved in a hit and run somewhere in Goa's border. We hooked him up to everything we had and maintained the monitoring. Nothing showed on the CT scan, so we just didn’t know why he was so unresponsive.

Friday and I'm back on call. The man is still breathing. No response to any external stimulus. I clearly remember remarking to a nurse that if he remained unresponsive for another day his breathing would surely give, and then feeling bad for being fatalistic. His blood pressure crashed towards the end of the day and I started him on the usual government supplied dopamine. This is part of the routine, which almost always leads to a death, but since my call was ending he would soon be someone else’s patient.

Saturday and he is still breathing. I am elated when I come in, maybe he will come back. We are still quite unsure about why he is in such a deep coma. Worse we still don’t know who he is and what happened to him. Around the evening his blood pressure stopped responding to Dopamine. Usually at this stage we start Dobutamine, as a final waltz to prevent Death. Thing is its frightfully expensive, so the government supplies it only on a local request. The formalities for this can only be done on Monday. But no Dobutamine and he would perish within hours. Truthfully the entire decision rested with me. Did I want to search for the money, cough it up myself if required, or let the man go? The nurse suggested looking in the rusty metal donation box, which is always locked because we’ve lost the key. Are the people we heal satisfied enough with our lack of care to donate to our ward? I looked in through the slit at the top of the box. It looked like there was some cash in there. Spent the rest of the evening scraping through that slit and retrieved some money. Enough to buy Dobutamine to last the man till Monday when the matron can get the government supply mobilized.

Monday He is still breathing. His circulation is holding with both Dopamine and Dobutamine. The police finally decide that an ad in the newspaper is the only way to find out about the man's identity. To last five days with only enough brain working to breath, in my ward, is nothing short of a miracle.

Tuesday, status quo ante.

Wednesday, his daughter comes in. He was a retired police officer staying with her. He had left home to visit some relatives. Since they all thought that he was with someone else, they never bothered to find out. Until she looked in the paper. She asked me how he was. I told her that the chances of him coming back were bleak but we were doing everything we could. The truth for once.

The next morning when I came in the nurse told me that he had passed away in the night.

Was he just waiting for his relatives to find him and pay their last respects?

I don’t know but I genuinely feel that there was more to him than can explained medically.