Recurring Nightmare 4

Please read Foreword first.


Recurring Nightmare – Internal Medicine

It’s been a good call so far. You managed to eat dinner, shower, AND watch the news while you eat supper before going to bed, so you are actually not annoyed when your pager beeps at midnight.

It’s a nearby ward. You decide to walk there instead of calling back.

When you get there you find the night nurse performing CPR on an elderly patient. Your houseman is at the head end of the bed, trying to intubate him. He looks up when he realises you are here.

'I can’t intubate him,' he says, his face a mix of panic and embarrassment.

'Don’t intubate yet. Just bag.'

He drops the laryngoscope and starts to bag the patient. You adjust his grip on the mask.

'Stop CPR.'

You watch the monitor as you feel for a pulse. No pulse, no rhythm. Pupils fixed and dilated. Doll’s negative.

'Continue CPR. What’s the story?'

'Er…'

'It’s OK.'

You pick up the casefile and begin to flip through the thick notes. You spot your own handwriting and remember you saw this patient during your rotation in this ward last month. Why is he still here?

You find the entry you need.

Not for active.

You walk over to the nursing counter to page the Reg.

'What are you going to sign up as?' he asks.

'The morning team wrote to sign as pneumonia.'

'OK.'

You call the time of death. The nurses start to clean up the mess. The houseman stands at the counter, not quite sure what to do. Second posting, but the first was in orthopaedics. You realise he is still in his shirt and tie.

'Give me your pager. Go take a shower. Page me when you are done.'

He obeys and runs off.

You sit down to write the death cert.

'Staff nurse, have you called the family?'

'Ya. They say they will come with the IC in the morning.'

You decide to write the casenotes instead. You flip through the old entries and begin to remember this case.

Came in last month with pneumonia, multiple co-morbid factors. Recovered after a course of antibiotics, but family refused to take him back. Five sons, lived with the youngest one, but when he was declared fit for discharge the son said he needed a few more weeks to get a maid and renovate the toilet to install a ramp. The other sons each gave their excuse. Social worker, Case Manager brought in, no progress. Weeks went by, no maid, no more visits, no news.

You remember him because at one point he was so well he would help the nurses hand out the afternoon snacks to the other patients. Why would he need a ramp in the toilet? You wonder what happened between him and his sons.

Then a few days back he fell sick again with pneumonia. Son finally came down when patient was put on 'Dangerously Ill List'. Decided not for active management.

You write your notes and walk back to the bed to hand the nurses the file.

'Page me when the family brings the IC. Thanks.'

You watch the staff nurse and the assistant nurse do their thing with a quiet efficiency. You never did find out where the hospital morgue is located.

The patient’s eyes are already glazed over, his toothless mouth open as if uttering a silent cry. The dead look ever so dead. You smile when you remember that you used to wonder whether it was possible to tell the exact moment when a person’s soul left his body.

The houseman’s pager beeps. You walk back to the nursing counter to answer the page.