They come in threes...

To finish out my last week in Whoop Whoop I've been put on night shift. Just me and around 200 patients who all want to exsanguinate on me overnight.

The first few nights were great, very few sick people and enough time to sleep for 3 hours per night. However such times are rarely sustained. Tonight things took a nose dive.

Started the shift with the evening intern coming to handover late as she had been caught up in a MET call resulting in a patient dying. She hadn't had a chance to clear the wards of jobs before handover so left me with a hospital full of 'stuff' to be done.

I trudged up the stairs and began sifting through boards of tasks for me to do. IV fluids needing prescribing, medication chart rewrites, cannulaes to be inserted. It wasn't long before I got my first call.

"We need you to come and look at this patient. He's not for resuscitation or ICU but for full medical intervention. He's unresponsive and has sats of 88% on 2L NP oxygen"

I arrived to find Mr A unconscious and unresponsive even to pain (not a good sign). His notes indicated that he had been rathe runwell and as the medical team could do nothing more for him, they were going to transfer him to 'rehab' to die. I examined him, detrmined he was probably sedated form benzodiazepines and in fluid overload with APO secondary to CCF. Gave him a whack of frusemide, upped his oxygen and called his wife to come in as his prognosis wasn't great.

Over the next 3 hours we battled to get fluid out of him, his IV access failing and his oedematous hands not willing to give me a vein to stab. I paged the medical registrar 3 times for advice with no response. Battling on my own with a patient who I knew had little chance of recovery. Thinking through every possiblity for any slim chance to help this guy make it through the night.

3 hours later, after fighting as much as we could, I found msyelf trying again to get venous access and as I stabbed his arm in futility, the nurse next to me said "Um doctor, I think he's gone"

Sometimes you fight and it's just not good enough. Sometimes modern medicine just cannot stave off death any longer. Sometimes people just die.

As I sat back (partially in relief and partially in shock) I watched as his frail wife broke down in tears and began beating him on the chest. "How could you do this to me? How could you leave me alone?" She began yelling at his corpse, pouring out her grief and anger at his death. I couldn't do any more, so I did the necessary examination to certify him, then left to fill in the paperwork and death certificate.

Then just before sunrise I got another phone call. "Hi just wndering if you can come and certify a death on our ward? A guy who had his fingers amputated this week"

"Not Mr R? I've been seeing him for the past few weeks? Wans't he ok?"

"He's not okay anymore... we found him dead on our morning rounds"

This guy had been operated on by our team earlier in the week and had been on the improve. His obs were stable all night long and he didn't complain of any symptoms other than a bit of finger pain from the operation. As I walked into his room, his familar face looked different. Pale and cold. Devoid of life.

After filling in his paperwork I went to the roof of the hospital to watch the sun rise over the valley. The fresh dawn air assaulted my face and I watched the slow crawl of cars making their way and starting their days. Despite the darkness of night, despite the death and futility, the sun still rises. The dawn still comes. Its funny how on night shift I wont see any deaths until one night, when they all come in a bunch. And always in 'threes'.

After I called the bosses to inform them in the morning of their patients demises, I walked out of hospital and crawled into bed. Feeling like I'd lost the battle, but knowing I'd win the war. At times like these, you can succumb to fatalism... the patients are all gonna die one day.. why bother fighting so hard? Or you can fight to improve the life of each person you meet. You may not be successful, but you've tried. And once in a while, very occassionally, you might make a difference. To not be content with the brokeness of this world and to fight for something better.