An elderly man lays propped-up on a bed, naked, a CPAP mask strapped to his face causing his chest to heave up and down unnaturally. His eyes occasionally flick open but he isn’t really with us. He lurches away as a catheter is placed and grabs for the mask but clearly doesnt have the strength. The rest of the nurses and doctors are busy placing cannulas and arterial lines.
“A fantastic 3rd heart sound to be heard here, Ash!”, the on-call Registrar calls to me, taking his stethoscope off. He looks at me expectantly and I dutifully step forward into the chaos. I heard the gallop very well which normally would have astonished me – right now I’m too stunned by the whole scene to take it in.
The ECG screen shows strange shapes broken up by big, broad, fast complexes – ventricular tachycardia. The trace turned into a squiggly line and then snapped back into the VT rhythm. The Reg looked at the nurse and shook his head. Ventricular Fibillation is never a good thing.
The Reg takes me to see the family where he breaks the bad news – their husband/father/grandfather isn’t doing well. He’s probably had an MI and this has led to acute heart failure causing congestion in his lungs – hence the CPAP and 3rd heart sound. His long-standing COPD isn’t helping.
The family fall apart, as expected. For some reason it doesn’t phase me – I’ve gone a bit numb. We take two of them to see him but they can’t make it past the door. I go ahead and make sure he’s covered up for dignity’s sake; it seems sensible. Eventually they come through to see him, tears all round.
There’s nothing more to be done for now, so I go off and practice bloods, cannulas and clerking at the Medical Assessment Unit. I came back later to find things much the same. I was still wearing my stethoscope from the MAU and this probably gave the family the wrong idea. They stood back as I entered as though making room for me. I can see the CPAP mask is now being held on by one of the nurses and offer to take it from her. While I hold the mask to the man’s face and fend off his lurches for it, the family look at me expectantly.
“The first bit is the worst bit, you hear from people – if they can get over that then he’ll be fine, right? We’re past the worst bit now, right??”
I honestly don’t know what to say but I’m acutely aware of the ethics (and rules) regarding medical students giving out advice. I just look at the son who asked the question and try to make a subtle, sympathetic face. The CPAP gauge fell off the bed so I have an excuse to break the moment.
After a while the Reg comes and calls me away to watch a shoulder dislocation being put back in. An IV drug user being brought back to life with Naloxone also catches my attention. When I next return to the old man’s bed I find it empty. He died being transferred to the ITU.
