SHORTSTORIES

SOME THINGS START BADLY, THEN GET BETTER, THEN END WORSE THAN EVER

On windy days doors slam shut sometimes. It’s nothing unusual.

IT WAS AN IMAGE I COULDN’T SHAKE

As an emergency physician, I’m a strong proponent of living wills, POLST forms (Physician’s Orders for Life-Sustaining Treatment), and discussing uncomfortable topics with your loved ones. Even making decisions about your child being an organ donor, if, Heaven forbid, something happened. You never know when the “last time” might be. A recent case I had served as a reminder of this. The patient and their spouse came to the hospital for what was supposed to be a routine outpatient procedure. While the spouse was in the cafeteria, grabbing a coffee or a snack while waiting, the patient suddenly experienced a low heart rate and weak pulses. A rapid response alert was announced overhead. The rapid response team swiftly assessed the patient’s condition and determined the appropriate actions.

The team initiated intravenous fluids (IVF) and decided to transfer the patient to the emergency department (ED) for further evaluation. However, while they were in the elevator, the patient’s pulses ceased, and cardiopulmonary resuscitation (CPR) was initiated. I had been informed about the patient’s arrival in the ED but was taken aback when the elevator doors opened, revealing someone performing chest compressions on the gurney. We immediately called a code blue and commenced resuscitation efforts.

Meanwhile, the spouse had returned to the waiting area, noticing that the procedure was taking longer than anticipated. Concerned, he inquired about his spouse. Staff escorted him down to the ED just as I was observing a motionless heart on the ultrasound, double-checking my options for further intervention. When the spouse arrived, I gently asked if he was aware of what had transpired. He only knew that a complication had occurred. Inquiring about the presence of a living will or do not resuscitate (DNR) orders, I learned that the patient had a cancer diagnosis and had expressed a desire to avoid extraordinary measures.

I proceeded to explain the sequence of events, inviting the spouse into the room and calling off the resuscitation efforts. With the exception of the patient’s assigned nurse, everyone left the room. During this time, the spouse revealed that they had recently celebrated their 59th wedding anniversary. He spent a few moments in the room with the departed partner before eventually departing. I inquired about family, to which the spouse mentioned that all their children lived far away. I asked if there was anything else I could do, and the spouse graciously thanked me for my efforts before leaving the department.

For the remainder of my shift, I couldn’t shake the image of this elderly individual slowly walking down the hallway, carrying their spouse’s belongings in a hospital bag, heading to their car to drive home alone and enter an empty house. In the brief moments we spent together, I realized they had likely kissed goodbye before the routine procedure, exchanged “I love you’s,” and continued on, unaware that it would be their final interaction. This realization brings me some solace, and I hope it brings the same to them.

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Veronica Bonales is an emergency physician.

But for the kid we treated with his index finger in the door-frame, it was a real nightmare. His painful howl made the entire neighbourhood scramble out for help. At that critical moment, despite the chaos and panic, his quick-thinking mom managed to put the amputated piece of the finger in a Ziploc bag along with some ice and brought it along to the ER. It was a wise move that surprised even the seasoned ER doctors.

The plastic surgeon on call attended the case and immediately went to work. The kid was anaesthetised and taken to the operating room. The cut piece of finger was surprisingly well preserved in ice. Tendons were sutured, nerves reconnected, blood vessels stitched together. After a grueling 8-hour-surgery, the cut finger was reconnected. While the kid slept in the recovery room with his finger bandaged, the surgical team kept their fingers crossed as to whether or not the finger wouldlive and hold.

72 hours later, chocolates made the kid giggle, and his finger-tip movement made the surgical team smile and his mother cry.

Three days later the kid was discharged on antibiotics.

Not the end of the story.

At home like any other kid, he wanted to play. His dirty toys, rusty soldiers and water pistols were not something that the mom endorsed. She was bothered by the possibility of infection to the repaired finger. To provide one more layer of protection, she put a “polyethylene cover” over the bandaged finger, and to prevent it from slipping off, she put a rubber band over it.

Two days later when she brought him for change of dressing, the finger had become black and gangrenous due to the arterial blood supply being cut off by the rubber-band; the comfortably snug rubber-band had become tighter because of the edema of the swollen finger.

The surgical team gasped in shock and blamed the mother. She sobbed silently, her image transformed from a sharp-thinking mom to an uncaring caretaker.

There was no other option: the finger was amputated. The kid’s wound healed and his physical debility would be minimal but the mother’s bruised psyche would never recover.