When Everything Goes Wrong

This morning was a disaster! As I sit at my desk, after taking a hot shower and eating lunch trying to decompress, I wish that I could start the day over. On rounds this morning, when trying to do my best for one patient, everything went wrong at the wrong time.

He was a 35 year old Kenyan who was admitted last night secondary to heart failure. Though he was having mild respiratory difficulty last night, he was not in critical condition by far. This morning on rounds, I found him in respiratory distress, working hard to breathe and unable to talk because all of his energy was being used to breathe. No pulse oximeter (machine used to measure oxygen saturation) was anywhere close. I firmly asked the intern to start the patient on face mask oxygen immediately while I went to look for a pulse oximeter. I walked briskly to the female medical ward . . . .no pulse oximeter. I walked even faster to the pediatric ward . . . they had a pulse oximeter but no probe (vital for the measurement). I jogged to the ICU and they had what I need. Upon arriving back the bedside and examining the patient again, his breathing became more labored and his heart was beating at a lethal speed, 180 beats per minute. I asked the intern and closest nurse where the EKG machine was . . . no one knew. I ran to the ICU only to be told that the two EKG machines in the hospital were not functioning properly. So I ran back to the male medical ward, rummaging around for a defibrillator machine . . .my only hope for visualizing a heart rhythm was using the paddles on the defibrillator. I found one and hurried to the patient’s bedside . . . no power. I attempted to plug it in . . . no adapter for the electrical socket. Three minutes later an adapter is found and I aggressively placed the paddles on his chest . . .his heart was still beat 170-180 beats per minute and the rhythm looked like supraventricular tachycardia (SVT). I knew exactly what I needed . . . .Adenosine IV. There was no Adenosine in the code cart. I ran to the pharmacy . . .no Adenosine. I ran to the operating rooms . . .no Adenosine. I found some Propranolol, a poor substitute especially given that the patient was in acute heart failure as well. I get back to the patient, his bedside was crowded with interns and nurses who were attempting to help, and his heart stopped just as we were attempting to administer the medication. As on of the interns was bagging him (giving oxygen manually via a mask) and a nurse was giving emergency IV medications per my order, I performed chest compressions for 15 minutes (which felt like eternity. All the while I knew that there was no available ventilator and no room in the Intensive Care Unit) . . . .no heart rhythm, his pupils were fixed and dilated, he was dead. I was in such disbelief . . .everything had gone wrong. Sure, I have seen plenty of people die, but I knew that he should not have died like this. I took it hard. I had the leave the ward and outside for some fresh air. I sat in the outdoor chapel and prayed. When I gathered my composure, I returned to the ward, prayed over the patient, and then counseled and prayed for the family. Finally, I let it go and resumed rounds.
 
I found strength in 2 Corinthians 4:7-11, 16-18. “But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body. For we who are alive are always being given over to death for Jesus sake, so that his life may be revealed in our mortal body. vs 16 Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes  not on what is seen, but on what is unseen. For what is seen is temporary, but is unseen is eternal.”
 
Im headed back to work. Just had to get that off my chest and mind.
 
Peace and blessings,
 
Darrell

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