The ICU diary . Part 1- Shalom makers

“Woman, you are set free from your infirmity.” Luke 13:12

Rotation to surgical ICU came as a whiff of fresh air to my course. From the daily rigmarole of breathing in medical gases and day long surgery lists, ICU opens the eyes of the anaesthesiologist to see how crucial his role is to the outcome of a patient and his family. ICU keeps us in touch with people who have relatives waiting to hear news that engenders life and death. It is those interactions with people that I often miss in theatre. Premedicated with anxiolytics a person coming for surgery does not even remember an anaesthetist post procedure. In popular medical worldview, the anaesthetist plays a second fiddle to the surgeon and the only reason his more enviable colleagues get along well is for an extra case to be done beyond the stipulated time. But I am inclined to think that it is a mistake.

The night before I went to ICU, I accompanied Anand for preoperative examination of patients. I met a lady named Priya(Name changed). Clad in her traditional clothing, she sat with her pregnant tummy on the bed with her elder son rolling about in sleep. A perfunctory look revealed that she was thinly built with protruding teeth and pale complexion. Since I was adept at Hindi which also was her mother tongue,we started talking.

In a north Indian slang, she narrated her history. She delivered her first child three years ago by Caesarean section- the famous operation where doctors cut the abdomen and remove the baby when the natural path down is unfavourable. This time a greater risk was lurking around. She was diagnosed to be having Placenta Accreta- a condition where placenta, the nutrient bag to the baby, gets too strongly attached to the uterus of the mother that it can cause life threatening bleeding. 

 Bleeding is a word that raises a red flag in an anaesthetists’ mind. Immediately Anand made sure that blood was available for the procedure. Since Priya had buck teeth we assessed if she could be intubated if need arises. An ICU bed was reserved for her just in case things went really bad.

The first day in ICU was unremarkable till I had to attend a call from Obstetric theatre. Priya had the worst possible complication one could think of. The anatomy of her pelvis was totally distorted due to her first surgery. The urinary bladder that generally slips away on retraction was tenaciously adherent to her uterus. The placenta on the inside was bound with equal tenor to the wall that fortified the live baby for 37 weeks. The cut on the uterus turned out to be a fatal incision. The bladder was cut and the vessels on the inside bled like a river that breached its banks. She lost about 5 litres of blood and around 11 packs of it was transfused in the theatre which meant that her entire blood volume was replaced by a bunch of charitable donors.

As she arrived crossing the glass doors that separated the sterile confines of the ICU, I really doubted if she would make it. On multiple inotropes- the life saving drugs that augment the circulation, she was in a really bad shape. Blood was flowing from the packet attached to a metal stand  to the neck where an IV was inserted. The falling blood pressure from a radial artery screamed on the monitor that she was edging towards fatal grounds. The heart was beating at the rate of 160/min indicating its inability to pump adequate blood to meet her body’s demands. The urinary catheter showed blood as red as crimson. All the blood that entered her neck came out through the bladder. 

Due to such a massive transfusion her natural coagulation went haywire. The natural tendency of blood to form a clot was lost in her. Tests were sent and results were bad. Packs of the red life fluid came in instalments and we would collect all the transfused blood through her urinary orifice. Repeat results needless to say were discouraging. 

If there is one thing an ICU doctor has to war against more than disease, it is discouragement. It is not the passive acceptance of terminal conditions I am talking about. It is the feeling that ‘we have done enough and nothing seems to be happening. Let’s give up!’ that one must guard his mind against.

It is then that heroes entered- the registrars from urology, like a monsoon in a desert land. I call them heroes not for their skill but for their tenacity. They kept on irrigating the bladder with normal saline for hours. They informed the staff to empty the urobag and inform whenever it gets blocked. They literally put their chairs in front of sedated Priya to see that her urine was cleared of blood. 

In the mean time the blood and its products were finished. The attender had gone to the blood bank long ago and there was little time to be lost. Then I was dispatched to bring blood. I had to run in cinematic style to fetch them. Blood bank personnel were more than sincere in handling our request.

At around 3 AM when the whole world was sleeping in ignorance Priya woke up to life. Her bleeding took a downward trend. Her heart began to slow down its frantic pace. Her blood pressure picked up. Her urine output increased. The drugs to help her circulation improve were not needed anymore.

The next day a CT scan was taken. The bladder had a massive clot sitting in its cavity. It was blocking the natural pathway for urine affecting the kidneys by backflow. An alternate path to drain the urine and save the kidneys had to be created. She had to be shifted to radiology suite and the anaesthetist  had to romped in. Like life coming a full circle, Anand was the anaesthetist for this procedure also. Tubes were placed in both the kidneys. Urine was draining free of any blood without any obstacle.  

Priya’s haemoglobin picked up. Her coagulation profile became normal. The next day the tube inside her windpipe was removed. She was discharged from the ICU. I met the husband of Priya as I passed the waiting corridor for lunch. He was smiling from ear to ear. I told him she was doing better. He nodded and thanked me.

As I walked past the long corridors of the hospital, I learnt a precious principle. Priya’s family  experienced a life altering episode. In this institution, she was touched by world class medical care that stands as a witness to the healing ministry of Christ. Some knowingly and many unknowingly had become the hands and minds of Christ in serving Priya. Her family was shown what an encounter with Christ and His love can be. The complete wholesome living – ‘Shalom’ can indeed be attained when God’s people work together as a single unit. The world always brings in criteria to create division- ‘He does not speak our language, he does not come from our state, he does not belong to our denomination etc’. But it is in our unity that His healing will fIow and it in our oneness that His Shalom can fill this land. In that sense we are all in the business of bringing Shalom to this land together. In that sense we are Shalom makers collectively than as individuals.