Sometime in 2012, it was my speciality posting in a corporate hospital. This was one of the gruelling postings in our anaesthesia post graduate career. It was extreme hard work. Our day starts at 6am in morning, a quick shower and run down to the nearest canteen 400 metres away. Have a filling of dosa and tea and run back to the hospital Cardiac Operation theatre to learn the nuances of cardiac anesthesia. Patients are usually wheeled into OT at around 7:30am. We need to ensure that all things are in place starting from the high end gadgets to the numerous plasters/sticking tapes cut to perfection to fix the tangling wires and patient monitoring lines in position.
“A safe OT is needed for a safe patient and safe anesthesia”
On any day the cases would usually last upto 4-5pm in evening if not more.
Evening would then stretch onto nights as I was in charge of any emergencies coming to the hospital, any patient who collapses may be in the ward or ICUs or casualty, or to give anesthesia to patients undergoing cardiac stenting in Cath Lab. So invariably we were kept busy at nights and into the next morning of routine cardiac OT.
One evening I got a call from my senior consultant who briefed me regarding a patient undergoing a elective surgery and who will need further care in ICU.
That was my first encounter with this man lying on OT table. His vitals were not stable and my consultant was putting a central line to start inotropes.
He was a man in his 60s, well built.
His brief medical history:
He had undergone heart surgery in the past due to a heart attack and now posted with acute cholecystitis (gall bladder infection) with sepsis.
Open cholecystectomy was done and patient was handed over to us to manage in the ICU.
His kidney parameters were not normal, Blood pressure was on lower side, known history of heart surgery and some of the heart wall being infarcted with poor Left ventricular functioning.
Extremely tricky situation for a PG trainee.
That day at night I was called by the ICU nurse as the gentleman was awake, restless and oxygen saturation was not maintaining. I rushed in and had a brief chat with Mr Viswanath for the first time. He was restless but still was extremely sober. Extremely sober for someone who had been a IAS officer and giving orders was a 2nd nature for them. I have come across many arrogant IAS officers just as you might have come across many arrogant doctors.
Such a gentleman and he showed immense faith in me not by words but by deeds.
(Intubating the trachea, i.e, putting a tube into your lungs so that we can push air into your lungs is an extremely painful process, Anaesthesia books have estimated this pain akin to a SURGEON PUTTING HIS SCALPEL TO YOUR SKIN AND MAKING AN INCISION!!)
Yes its that painful and the whole body’s vitals goes haywire. BP, HR everything becomes uncontrolled. But a OT set up and a icu setup varies a lot. To avoid any major fluctuations in BP or myself failing to intubate him in first attempt.
I asked for his help, to cooperate when I would like to just have a look at his throat and then withdraw my laryngoscope under minimal sedation.
Mr Viswanath said ok doctor go ahead, he simply opened his mouth and lemme have a look at his vocal cords and few tears rolled away in pain, and I was able to intubate him in few seconds.
I have never seen such a patient till now. So much obeying and cooperative in a critical condition!
This amount of faith on a junior doctor was incredible. God was there with me and I saved him from the sufferings. Ventilator was connected and I could put him to deep sleep as now no worry that he might stop breathing under sedation.
But the bacteria and organisms in his blood were playing havoc inside him. His lungs were infected and kidney was giving up. Over the next few days I was putting my theoretical knowledge about ventilators to use on him so that I could soothe him in some way. Make his breathing a bit easier, take away some of his pain. Even when on ventilator he used to open his eyes to see me and give a smile and the next instant he would drown in his vigorous cough and struggle with the foreign tube in his lungs, again I would put him to sleep deep.
Outside of the ICU there were his son and daughter in law, ever anxious. Son who was a IT professional was as sober as his father, for the first time I saw a IT professional who understood medical science 1+1 may not be 2 and it can be anything from negative to 100. They also trusted me to bring their father back from arms of death. I had sleepless nights besides Mr Viswanath and the ventilator learning the parameters of ventilation and what exactly causes a dyssynchrony between the patient and the machine.
Each passing day the antibiotics were playing with us. One day the Chest X ray would show clear lungs giving me hope that tomorrow I will remove the tube and talk more to this gentleman, but again the next morning infiltrates in the form of devil would come back to haunt me. Nephrologists, Cardiologists and other specialists were roped in to give vital inputs. I was silently watching the son agreeing to the slowly piling heavy hospital bill and I so so so wanted Mr Viswanath to give me a chance to remove the tube and relieve the family of their worries. I successfully extubated him one morning and he was ok for few hours and again smile at me thanking me for being with him. I was so happy and went to take a shower and some rest with my heart filled with joy. But by evening I got the same call from ICU that Mr Viswanath was not maintaining his vitals and I may rush in. I ran back and once again intubated him after having a brief discussion about his condition. Intubated him in seconds and put him to sleep. Again kept trying my best from the knowledge I had.
But next day his heart stopped working, I tried all CPR and every trick we learned of resuscitation but alas I could do that much. He left me empty handed, lied their motionless, the same calmness and trust he had shown in me the first day I had put him on ventilator.
I stood still, I lost to life and I lost to God, I lost in front of the son and daughter in law who would take details about their father daily.
He may have left this world but he taught me how to manage a patient on ventilator, how to watch every breath of a patient and then adjust settings. How to be that link between machine and human!
I hope you live here in the internet jungle as this story and your courage gives some inspiration to a young doctor to treat the patient and not the monitor.
I will never forget you Mr Viswanath