The first thing I remember about him was the blood leaking out of his fingertips on the ground. I had never seen so much ottorrhagia before.
Groaning, struggling to keep his eyes open, he was somewhere between life and death. The emergency room floor was full of blood. It appeared as if we were walking in a shallow lake of blood!!

 

The nurse was trying to intubate him when I shouted: First Collar! Also two IV lines!!!!

It was weekend and most of the doctors were away.  No Anaesthesiologist, no Surgeon, no Internist…

I was the only physician in the little town on that weekend. The nurse was unable to intubate the patient by Collar, so I had to do that by myself.

There was a lot of bloody secretion inside his mouth.

After using 3 intubation tubes, I was afraid to try more. There was no Packed Cell in hospital and the patient bleeding was more serious and concerning than his breathing.

Therefore I decided to send him out to a more equipped hospital in the neighbouring city which was half hour away along with two nurses and a referral note.

Through this uproarious situation, when finally I raised my head, I saw a little girl with fearful and worried eyes, peeking around the corner of Emergency room behind her crying mother. Her little eyes were looking for her father’s saviour angel inside me! An angel with white scrub full of blood stains, who knew that she was not angel and just like her prayed for the little girl’s father from deep inside to survive before reaching the hospital with requisite facilities.

 

******************************

I still smelt blood in my nose when the Nurse said that the wounded man died before the ambulance reached the other hospital.

In deep sorrow, I was trying to concentrate on another patient when the phone started ringing .It was the surgeon of the neighbouring city hospital on the phone, yelling at me madly demanding to know why I had not incubated the patient.

” I tried my best but it did not work…with collar and so much bloody excretion in the mouth, it was almost impossible!” I said.

“You must have intubated him, no matter how!” he replied furiously.

“I am only a GP; this patient intubation should have been done by an Anaesthesiologist. Even the operation room personal are on leave today. Whom should I have asked for help??”

For a few moments, no reply from him and then I heard the extended beep in the phone…

“Should I have tried more? Could I have tried more? “

Turning the pages of the book, I started reading the Contraindications of intubation again in a patient suspected of base skull fracture. The only feasible intubation can be done without extension  of the head.

The surgeon didn’t forget about the story, he decided to call up the hospital chief. The answer was the same.” Only an Anesthesiologist was capable of doing this patient’s intubation“

Nevertheless I kept asking myself: “Did he have any chance to survive after this massive bleeding even if he had been intubated? If I had done intubation for him in the extension position, he would have stayed alive but most likely become paralyzed and for a life time moved on the wheel chair! Could this have been a better alternative for him? If I did so, wouldn’t he get upset with me? What could be really his own choice? Life on wheel  chair or death? Had I made the right decision ? He might have wanted to stay alive even if it cost him a life time paralyzed on the wheelchair! “

For the first time I had realized the depth of the ocean I was swimming in.

I had to choose between the most difficult options for another person.

After a few days we received the Autopsy results:

“Base of skull and C2 fracture “

And this was verification of my right decision. However I still smelt the blood of that man…I remembered those little eyes following me through the partly open emergency door, assuming I was an angel. But I never was and will never be the angel.

Only for a moment, I became the little angel of a world as big as the Emergency room and the intensity of this commitment had bent my shoulders may be forever…

 

About the Author: Dr. Faraneh Oraei Abbasian is a physician (GP) at Mashhad University Of Medical Science , Iran. She is an active blogger in persian language. She can be reached at:  [email protected]

 

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