My Favourite Patient

My patient died .. The nurses called to tell me that her pulse rate was 30, and her diastolic BP undetectable. While i was contacting my senior, they informed me that she had no systolic BP. My senior told me to stay put, as the patient had requested not to be resuscitated if she collapsed. I shut the phone, and stared uselessly into the space in front of me. The tears flowed down my cheecks without warning. I missed her already.

Laila had been admitted to our ward two months earlier, complaining of difficulty in swallowing food and drink. A series of investigations revealed that she had a malignant tumour blocking her esophagus, and preventing anything she ate or drink from passing through. Though she was suffering from a serious disease with devastating stmptoms, I used to see her walk around four-five times a day to excercise her legs. She had great spirit, and was extremely patient with me, my fellow colleagues and the nursing staff. Every morning I would ask her how she was, and she would smile and answer, "fine." I would have to ponder her with questions to get her to reveal what she was really feeling; constant nausea, hunger and repeated vomiting.

The management plan made by the consultant was surgery to remove the tumour. At first she was reluctant to go through such a major surgery. She was 70 years old, with a chronic heavy smoker's lung. She was afraid she would not make it through, but gave in with the hope of being able to have a decent meal after surgery.

During surgery, the tumour was found to be unresectable. So, it was left untouched, and instead, a channel was made to transport smashed food from an opening in the skin through to her intestine directly. The fact that the surgery had failed, depressed her even more than the cancer itself. Unfortunately, even the feeding channel failed to function, and she was kept fasting, and recieved her nutrition through a catheter in her neck veins.

From that day onwards, I saw her deteriorate progressively. She refused to get out of bed, and her emotions became more blunted as time passed. When I asked her how she was each morning, she would turn her head and curl her lips in a sad frown. I urged her to get out of bed and take a bath, and she would finally give in and have a bath once a week. But that was it.

One morning, I went to check up on her, and found her gasping for breath. My heart started pounding, and my vision was blurred with tears. I grabbed her file and hurried away to pull myself together. I sat at the nurse's station and took a few deep breaths before opening her file. I was surprised to see four new entries all written by strange doctors the night before. I read through the notes hurriedly, and realised she had been seen by a surgeon, anaesthetist, cardiologist and nephrologist all in one night. She had developed acute renal and heart failure overnight. She was evaluated by all four specialist as being critically ill and in need for intensive care. I went back to her bed-side, and began calling her name, asking her questions, but she did not respond. "Is everything okay here?" It was my senior. I told him that she had deteriorated last night, and is in very bad shape. He told me this was expected to happen sooner or later, and there was nothing we could do. She died that day.

We were on-call when she passed away. It was the first week of the holy month of Ramadan. These days were very blessed among muslims, and it is beleived anyone who dies in Ramadan, is spared the harshness of death and the darkness of the grave. If so, she deserved such a blessed death...