Mrs Edwards, an engaging woman, was a grey-haired sixty-five year old cockney; a textbook one at that. She always had a cheeky grin and a joke up her sleeve. Her death was to be the first and the most disturbing one I had witnessed so far. She’d come in for a routine gall-bladder removal. Her symptoms were intermittent upper abdominal pain and X-rays showed gall stones like many people of her age. She’d been told that there was a chance this operation would probably fix things. This gutsy old bird was willing to try anything but her decision to have this operation was a fatal one. I was her student doctor – not yet qualified.

“Well deary, in a couple of days I’ll be out of here and back on my stall in the Portobello Rd”. She sold nick knacks and souvenirs – genuine articles from Hong Kong, “You’ll have to come and have a stout with me at the 01d Bull when I’ve recovered. I’ll show you how the other half live and we’ll have a game of darts. I’m a dab hand.

I told her that I would love to have a stout with her. I took all her details, wrote up her case history and arranged blood tests. She was scheduled for surgery the next day.

As the anaesthetist put her to sleep she managed to let out, “See you in the soup, deary”. These were to be her last coherent words, As she went off, she almost managed a wave. She would be dead in six hours. The anaesthetist was in the process of putting a tube into her lungs, so as to connect her to the ventilator, when, out of the blue, she vomited a copious amount of acidic smelly liquid.

“Jesus, she has inhaled it”, said the anaesthetist in a whispered shout and all hell let loose. The operation was cancelled. She was shifted back up to the ward where X-rays were taken. Her lung fields were a white out. The acid from her stomach was attacking, digesting them. The whizz kids were called in. She was filled up with various drugs to try and reduce the inflammation which was rapidly developing in her lungs. The decision to put a metal tube into her lungs to suck out the acid was made.

She was coming round a little.

“Shall we give her an anaesthetic first?”

“I’ll call the senior anaesthetic registrar”.

He arrived and took one look at her and said she was too sick for gassing. “We’ll do it without, then”. The steel tube was pushed through her mouth and into her wind pipe. She was bucking on it like a hooked fish. ‘Was she conscious enough to be aware of this’, I wondered? They seemed to spend ages sucking her lungs out. I was feeling sick watching her wriggle on the end of this tube. I felt a scream inside me, “Leave her alone, leave her alone you” and I said nothing. I folded my arms and held onto myself. I was the most junior person there. I stood stunned and silent; after all they were trying to save her and they knew what they were doing.

“Her ECG (cardiogram) shows a heart rate of 180 and she is going into heart failure. She is in atrial fibrillation and we’ll have to reverse it. Get the defibrillator. ” Six times they blasted her body. It jumped off the bed
and she let out a groan each time they shocked her. The heart rate did not change. ‘Jesus’, I can remember thinking. ‘If someone had done this lot to me. I’m sure my heart rate would be doing the same thing’. I desperately wanted them to stop.

“Come with me”, I heard a whispering voice in my ear. I felt a hand pulling on my arm. It was a friend. “Come and have a drink”. He took me down to the bar and gave me a double whisky.

“You look awful, what is going on? Tell me about it.”

“Well I,…” I didn’t get any further. An emotional out burst took over. I stamped around the bar. “Those fucking bastards, those bastards”. My rage went on for what seemed like an hour and then I started to cry. I was sobbing. “Why?”

“The couldn’t just let her die. It’s possible they could have saved her. If they’d just let her die, they’d never know whether or not they could have, they’d be vulnerable for legal action too for not doing their best. I am sure she would have preferred they gave it a shot.”

My friends words sounded hollow. I went back to the ward to find Mrs Jones in the bed covered by a white sheet. I noticed a get-well card on her side table. ‘Come home soon Honey. I love you, Frank’. I pulled the sheet back. She looked peaceful enough

I was soon to learn that most dead bodies do, death brings muscular relaxation.

No stout at the 01d Bull,

PS

I have scratched the comments I made previously. They were a bit incoherent.

The risk of dying from an elective procedure involving a general anaesthetic is tiny but it is there. In this study it was somewhere between no deaths for those under 35 years of age on up to 1 to 5 per 1,000 procedures in those older than 35. One of the causes of death is inhalation of stomach contents. This is why there are rules about when to not drink and eat prior to an anaesthetic.

Life is such a tenuous affair. Here one moment and gone the next. Once gone there is no coming going back. Mrs Jones was such a vivid memory for me. The attempts to save her, looked like torture. I swore I’d never do a similar thing to another human being. Now I know I could and would, if I was in the same position as these doctors. It didn’t work for Mrs Jones and will have and will do for others. This type of situation is such an awful, horrendous and shocking experience for all, in anyway, involved; life, careers and so much more at stake. How much suffering would you be prepared to go thru to remain on planet earth?

My dad was a rural family doctor. He and his partners ran a small cottage hospital – they delivered lots of babies. One day after a delivery the women’s uterus inverted. This is a very rare life threatening occurrence. The hospital was 30 miles from nearest major centre. Crash and obstetric teams arrived. It was a six hour or so ordeal. There were no winners. The baby survived and so did the mother minus her uterus. My mum told me my dad visibly aged that day. It clearly poleaxed him. He probably felt it was his fault. Was it? Could he have prevented it? He said he’d followed the correct procedure when I asked him.

Most medics are not psychopaths or sociopaths, they not only feel the pain of others, they feel their own.

My wife while in hospital with me by her side collapsed and nearly died in front of my eyes. I watched as the crash team fiddled around trying to find and gain access to some veins. They failed several times.

I had two perspectives. One of ‘having been there’ myself, attempting to gain venous access with difficulty and all the feelings associated with this and two, this was my wife bleeding internally, losing consciousness and clearly going to die if they didn’t get access soon.

Once they did, I lost it. A nurse guided me out of the room. I was stamping my feet and emoting. Why don’t you let her die I was blurting through my tears.

She’d been admitted 2 days before because of internal bleeding. A scan had shown two large and lots of small lesions in her liver and some in her lungs. She’d had a low risk breast cancer removed 12 years before. I knew she now had metastatic breast cancer.

“We don’t know for sure she has cancer. The specialist thinks they might be haemangiomas and these are benign, not malignant, treatable”

This stopped me in my tracks.

It turned out I was wrong and so was the specialist. My wife died 4 weeks later. The cause liver failure. The lesions were a very rare form of malignancy – hepatic-angio-sarcoma, a malignancy, the cells of which, double in number every two to three hours.

Would it have been better to let her die? The cost was over 850,000 dollars. During those four weeks she was never alone. We, Zoe Jake and I took turns at night and most of the daylight hours we were all with her except for breaks. She had video chats with family from over seas. We had a facebook messenger page filled with poems, videos, music and expressions of love and appreciation which she got to read, see and hear. The morning of the day she died, she told me in a calm peaceful way I am dying Andrew. As she slipped into coma her sister and brother from the UK spoke words to her, were with her. She was snuggled up to by Zoe and Jake. Her favourite music was playing. She died in their embrace.

On her ward, which consisted of private rooms, I’d see through the doors other people whose lives were in the balance. Many were alone, for most of the day, some seemed to have no visitors, so sad, such a contrast.

I am glad Tish was resuscitated. I am glad my command that they let her die was not obeyed. They probably would not have obeyed me anyway. If I’d insisted security would have been called. There was no no resuscitation order. Another person claiming to be her husband might appear and other family members might sue. In the States as I understand it, if there is no do not resuscitate, a person arresting will be resuscitated no matter how old or sick they have been.

What if a fruitless attempt to save a life leads to bankruptcy and all the issues that will follow on from that?

Back to Mrs Jones and her gallstones. About 20% of women will develop gallstones. 80% of those with gallstones won’t be troubled by them. I have experienced a few woman having their gallbladders chopped out and their pain symptoms recurring post surgery. This pain clearly wasn’t due to gallstones and of course many woman are happy with the results of surgery. Just because someone has gallstones on scanning doesn’t mean they are the cause of their pain.

Sent from my Samsung Galaxy smartphone.