The weekend from hell

I recently finished the worst weekend on call in living memory (my living memory in any case). Saturday was spent shoving various lines into a 76-year-old man's neck and groin and filling him with fluid, antibiotics and anti-fungal medication. He was an old patient of mine who had ulcerative colitis. He first came into hospital in October with a flare-up. Various things happened; he ended up having his colon removed and a very stormy time with a perforated ulcer, double pneumonia and Candida septicaemia. I saw him just before Christmas and he was much better - he just needed intensive physiotherapy to get him back on his feet, so my consultant sent him to the rehabilitation ward. When I was called to see him urgently on Saturday morning he was unconscious, with a very low blood pressure, acidosis and very low blood oxygen levels. He was severely dehydrated and in septic shock. He had not had his vital signs measured for two days (on meidcal wards nursing staff routinely do these every four hours, but this does not happen on the rehab wards). In short, he was about to die. I moved him to an acute ward and spent most of the day trying hard to keep him alive. He died just before my shift finished. I had to tell his family, who were devastated and could not understand why this had not been caught earlier. Neither could I.

Whilst I was still dealing with the above gentleman, a man came into A+E with complete heart block . He was seventy years old and had never been ill a day in his life. We couldn't get his heart to speed up despite drugs and external pacemaker pads (which basically shock his heart at intervals to stimulate a heartbeat). He stopped breathing several times before we got a pacing sheath into his jugular vein and got him to thex-ray room to insert a temporary pacemaker, which was unsuccessful because we couldn't get his heart to respond to the pacing impulse. He did however regain a normal heart rhythm spontaneously, but the ECG showed signs of a heart attack. Those same ECG changes can also indicate that the pacing wire has put a small hole in the right ventricle, a recognised complication of this procedure, which was performed by an experienced registrar. He was discussed with a cardiology consultant at another hospital, who recommended clot-busting treatment for a probable heart attack, despite the risk that it may not have been a heart attack at all but a hole in the right ventricle. This caused him to bleed profusely into the sac around his heart. A drain was inserted into this sac and he drained two litres of blood from his heart overnight but remained fairly stable. We gave him blood and clotting products to reverse the effect of the clot-busting treatment. Later the next morning, his heart stopped. We began to resuscitate him. I got a large syringe and began sucking blood out of the sac around his heart.

It was like a scene from a bad horror film. I had a bucket of blood next to me on the bed, into which I would throw full syringes after sucking blood out of the man's chest. Each time, someone would hand me a new one, and I would carry on. I was covered in it. After I removed about half a litre of blood, his pulse returned and we recorded a blood pressure. My registrar got onto the phone to London to arrange for him to be transferred for urgent cardiothoracic surgery. Ten minutes later, he lost his pulse again. We never got it back.

His family were waiting outside, and one of the nurses went out to tell them that he had died. We frantically tidied him up, mopping up the blood and hiding the bucket. We covered his body so that only his kind, sweet face remained exposed so his family could see him. His wife was so distraught she couldn't support her own weight. All the nursing staff and the entire arrest team were in tears. He had never been ill a day in his life.

After that, I dashed outside with one of the junior doctors for a much-needed cigarette. She was upset, but more than that, she was upset at herself for being upset. She told me what many people might think if they read this - 'This is our job, this is what we signed up for. We shouldn't be getting emotional or upset about things like this - does this mean I'm not cut out for it?'. I told her the truth, what I believe anyway - 'Nobody should be cut out for this. If you get used to things like this, then it's time to change profession'.