Sunday, April 20, 2014

A Matter of Life, Death, and Sparkles

     I apologize for posting so late!  Our internet has been shotty at best and I’ve been sick for most of the week.  This post is in regards to my fourth clinical week, where I was placed in the Out Patient Department (OPD).  I must warn you it was not an easy start to the week.

     Monday morning… 8:30am…  I had just finished my initial tour of the unit when the first dead body came in.  Carried in by the arms and legs by four men who may or may not have worked for the hospital or even known the victim.  In the emergency part of OPD, there are no doctors on staff.  Long story short, I participated in declaring the patient dead – not something I was ready to process at 8:30 Monday morning.  I can still hear the heart-wrenching, wailing songs of his mourning relatives.  Then the second patient came in.  She was alive, but just barely.  A case of end stage HIV/AIDS; she was so skinny, the blood pressure cuff couldn’t get a reading.  The sound of each breath made me wince, and she was going downhill fast.  I ran to get an IV bag of saline from another department while someone else started an IV.  By the time I came back with the saline, they were doing CPR.  A clinical officer and I kept up the CPR and ventilations for a while, but to no avail.  She was gone.  As we put the resuscitation equipment away, I got to thinking: why had we been thumping on her fragile chest and inflating her sick lungs in the first place?  If we had managed to restart her heart or her lungs – would she was been “saved”?  No.  A beating heart or inflating lungs alone would not rid her of the virus which had overtaken her body.  In her case, even ARVs were useless. By the time she was brought through the OPD doors, her body was shutting down.   So why did I feel so obligated to do CPR on this dying woman?  Simple: I am trained to keep people alive.  In medical culture, prolonging life is often the ultimate goal.  However, experiences like this remind me that death is also a part of health care.   

     Anticipating and planning for death seems like a morbid concept at first, but it also seems unfair to take control away from patients in their last moments of life. By assuming that this woman would have wanted air pumped into her failing lungs, I was putting my needs above hers. In my defense, I had no way of knowing her wishes, and airing on the side of caution seemed to be the obvious choice.  Even in Canada, end-of-life care conversations are often overlooked or avoided altogether. I suppose palliative care might be perceived as a low priority in a low resource country, but this woman suffered for the last few moments of her life because we didn’t know what else to do but try and bring her back.  It’s obviously not a comfortable conversation, but as I finally took the bag-valve mask off of the woman’s face, I really wished I knew that I had done the right thing for her.

     On a MUCH lighter note, Caitlan, Lauren, Aileen and I spent Thursday of last week at a school teaching 5 year olds about health!  After such a tough start to my week, teaching little kids to wash their hands and brush their teeth was like a breath of fresh air!  Health promotion is something I am very passionate about, and kids are especially fun because you can make it a game!  Check out the picture of Aileen and I with our group of kids; we’re all showing off our sparkly, “germy” hands! 


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