Devo

Yesternight was emotional.  My patient died.

Knowing his condition, I knew he had a bad prognosis.  But in the midst of his very loving and hopeful parents, it was easy not to think that he'd be gone on that bed, during my tour of duty.  The sad part is that, his parents had made the decision to go home so he can enjoy the company of his siblings and relatives instead of hanging out in the very infection-laden ward and endure the agonizing IV insertions and blood extractions.  They were just waiting for the van that would take them back to Sariaya, Quezon.

Guess the decision was a day late.  That evening, the worst happened.  His lungs gave way.  He was in respiratory distress.  The resident on duty decided that it was best to intubate the patient so we can help him breath.  His parents, seeing that their son was turning blue due to the lack of oxygen, agreed to the procedure despite the fact that they felt strongly against it.

And so it happened.

His mother was  holding his lower extremities.  His father was kneeling, barely looking, while the intubating team was around Ebo, preparing the intubating stuff, donning their gloves, watching for his heart rate.  I was, all the while at another bed, ambubagging the newly admitted newborn who has gastroschisis because the rented mech vent was malfunctioning (hay respi globe..).  

They were successful.  

And then after a few minutes, a huge amount of frothy and bloody substance was coming out of his mouth.  We knew he had a problem with his clotting factors, that's why he was transfused with several units of fresh frozen plasma.  He was bleeding.  His mother was hysterical.  CODE was called.  The resident started to do chest compressions, while his parents were jumping, running and shouting tama na doc, maawa na kayo, tama na po.  His dad was crying, holding on to the bed, too afraid to look at his bleeding son.  The mom decided not to have any more intervention.

Devo was dead. 

It did not sink in to me yet, as I was making sure the other patient was not hypothermic and with good vital signs.  When a resident took over, I went over the bed to help in removing the IV line, the tube, etc.  That's when it did sink in.  Seeing him dead was something.  I dropped it, went to the callroom and cried.  All I could say was, I'm sorry Devo.  If only I knew things would turn out as it did that night, I could have pushed them to go home and spend his last days with the people he loved the most.  Not with us.  Not with all the medicines.  

But I didn't because I felt it was cruel to tell his parents the truth - that their son will surely be gone soon, especially that the chemo cannot be started soon.  I guess I was wrong.

When a patient dies in the wards, the body and the relatives will stay at the bed for at least an hour because papers will have to be processed and they also have to wait for whoever is going to fetch the body.  There comes my problem.  I did not know what to say to his parents.  I felt like evading them though I know that I should talk to them and say my sincere condolence.  

His dad made the first move.  I was monitoring a patient when he came over, tried to compose himself and said, Doctora, maraming salamat sa lahat ng tulong ninyo sa amin.  I cried in the middle of the wards.  I ushered him to the curtain-covered bed of Devo.  I said I really wanted to go to them right after what happened but I did not know what I'm supposed to say.  I told them I'm sorry for what happened, that we did what we felt was best for the patient.  They assured me that they felt I did what I had to do and more.  They told me that they are not blaming anyone.  It was just Devo's time to go.

They bid me goodbye.  Their relatives have already arrived with the van that's supposed to take them back to Quezon.

Truly, the essence of what we do is highlighted whenever we are faced with birth or death.  We deal with life, and all that comes with it - patient's family, dreams, future.  But there comes to a point when we should know when to stop and make them choose how they want to spend their life, especially when the last days are few.  Personally, I wouldn't want to die with a tube down my trachea, with people I barely know.  I'd like to die embraced by the people that matter in my life.  

I could've told them earlier.  I should have told them earlier.  But as his father said, he knew I did everything that I thought was best for his son.  

I only hope for my patient's peace, and his family's acceptance.