I had an hour left of my ten hour shift when a patient had a sudden and unexpected cardiac arrest in the emergency department. I took over CPR on the third cycle (doctors and nurses rotate giving CPR every 2 minutes to minimise fatigue and maintain strong compressions). By the time my hands were on the man’s chest, there was already a tube down his throat allowing another doctor to provide artificial breaths, multiple lines into his veins delivering adrenaline to try and encourage his heart to restart, and he had been shocked with a defibrillator twice. It was a very odd sensation to finally be delivering cardiac compressions to a real human after so many simulations on dummies. In other resuscitations I’ve been involved in, it was my job to get another drip in, or to get the latest blood test results or send more blood off. My own pulse was skyrocketing as I climbed on top of the hospital bed and started pressing down on the unconscious man’s chest. Several of the man’s ribs were already broken, and his sternum was freely depressible deep into his chest. Try pressing inwards on your own chest - it doesn’t feel like one of those CPR dummies… but I can tell you that once the ribs are broken by the initial compressions, the dummy is a fairly realistic simulation.
I did several cycles of CPR throughout the resuscitation effort on this man. While my hands worked to try and squeeze his heart to deliver vital blood to his brain, a flicker on the defibrillation monitor and a hand over his carotid artery showed that he had regained a pulse. For a split second it seemed things were looking up and my own pulse again was racing. Unfortunately a swift ultrasound of the heart and another glance at the monitor painted a more dire picture. After close to an hour of CPR, defibrillation, drug therapies and ventilating by a team of doctors and nurses, further efforts were deemed futile. The entire team stepped back in silence as the head doctor solemnly announced “time of death, 10.48pm. May he rest in peace”.
I have witnessed the final moments in the lives of many patients. Whilst working as a nurse, I held the hand of an elderly lady as she gasped for her last breath. I have examined recently deceased patients to certify their life extinct. I have made the awful call to family members to give them the heart-breaking news that their loved one won’t live to see another sunrise. But this death was different.
This was first patient whose chest my hands had worked on to try and bring back life. This was the first patient who I witnessed complete the transition from life to death whilst working as a doctor.
It says a lot about us as doctors and nurses that after a brief pause to debrief and regroup, we all dove right back in to the rest of the department, where every other patient is unaware of what we have just witnessed. We all become a bit desensitised to just how profound it is to witness another person’s final breath, and this is necessary to some degree or we just wouldn't be able to function. It is easy to forget that we really are in a privileged position to be on the frontline to be involved in other people’s lives beginning, ending and all the most difficult moments in between.