The ICU diary- Tragedy and Thankfulness

“I cried that I had no shoes, until I saw a man with no feet”- Anon.

‘What we do in life, echoes in eternity.’- Gladiator (2000).

 Beds in surgical ICU churn out strong lessons to a registrar. The lessons are not always academic but  also transformational. I just finished my rotation of critical care mandatory to my course and a family still lingers in my mind as I walk over the glint of a floor that bears stories of tragedy and hope in equal measure.

A month ago, on one of the dangerous roads of our country, a family was riding in a car. The father, a sexagenarian along with his wife and daughter were riding along blissfully oblivious of the tragedy they were about to encounter.  The vehicle skid over the rough contour of mortar toppling the 1000 cc car thrice before reaching a halt.

The three casualties were brought to emergency. The father was bleeding into the abdomen. A CT scan showed a big clot around the kidney and his blood pressure as a result was dropping. That is bad news because if the pressure of 'life fluid' is not adequate, all organs would begin to shut down pushing the person towards death. The father was taken to what is called a DSA suite where organs of the body are scanned in real time and the bleeding vessels are cauterized. The procedure went on as planned with the father being shifted to the ward.

The following day, he began to lose blood from an unknown source with serially dropping hemoglobin levels. Further evaluation showed that his blood was showing abnormal coagulation. All factors that were meant to clot of blood were dysfunctional. Blood began to flow like a river with no impediment. We were transfusing blood and the factors needed for clotting. It was just like pouring precious wine into a torn wineskin.

 Throughout this episode, he was conscious and would look about the white lights that illuminated the ICU. He was not intubated (a tube put in a person’s windpipe to provide an artificial path for air to reach lungs) which is a rarity in surgical ICU. He would nod and answer questions which reflected his good demeanor. I later learnt that he was a school principal and his vocation had a good influence on him. He would ask for water and time occasionally. Otherwise he was a quiet customer.

On a Sunday morning, he suddenly became unconscious. He was not responding to pain. His pupils were not equal in size. This meant that something at that point of time happened in his head. We immediately intubated him, took him for a CT scan of his brain this time that showed blood. The vessels that carry the fluid of life had given way.  Blood was filling into the brain and within an hour a man who was expected to go home had tumbled down to a condition with mortal prognosis. The daughter who herself was injured in the mishap but escaped with minor injuries was a brave heart. When explained about her father’s predicament, she was wise enough to see the fact that there was no point in letting her dad stay in ICU any longer. She wanted to take her dad home. We consented. I came home after an eventful duty.

The next day there was a 60 year old lady who was admitted into another bed of the ward. She apparently had an accident and became paralyzed from chest downwards. She was taken to the general ward after admission and since she was restless with poor oxygen levels, she was brought to ICU. She was breathing through a facemask. I perfunctorily looked at her records. Her husband’s name startled me. It was the man who left ICU the day before probably to another world by then.

Hours later, the woman had few visitors. They told me that the old man had passed away just as the ambulance approached their home. The women did not know that her husband was dead. After a couple of days in the ICU, she was stable enough to be shifted to the ward. On many an occasion, she would ask for her husband. I would nod and just walk over to the next patient. As her trolley rolled past the doors of ICU, she did not yet know that her husband was no more. By now she must have known the truth and this pain would have been more excruciating that the road traffic accident.

How frail our lives are and how temporary! We are so busy planning our lives for the next two decades. But a topple of a wheel, a skid of a vehicle can let our lives go haywire. Our roads, our vehicles, our houses, our food, our lifestyles are all waiting in the shadows to cast their paws of death upon us.

How shall we live then? One thought that came to my mind instantaneously was thankfulness. I see so many issues in my life that cause me to simmer in discontent. I plunge myself to depression that I do not have a better vehicle; I do not have a better specialty; I do not have a bigger house; I do not have a better computer etc. It always feels that neighbor’s lives and goods are more attractive and productive. But as I listen to stories from ICU, I am humbled and gratitude overflows towards God and all He has given me.

Life is so uncertain and has no guarantee.( the most common question attendants ask in casualty –“ Do you guarantee that my patient will become well?”. The fact is there is no such thing as guarantee for life.). We are all going to pass one day. Death I feel is such an anticlimax for all the pride, glory, power and achievement we engender to our lives. There should be something beyond the grave. Or else all human effort would be utterly futile.

 May be we should start looking at life from heaven’s perspective. May be death is not the end but just a passage to eternity. Heaven must be the culmination of all our efforts and all our pursuits. Because heaven alone is permanent and it alone provides the only viable and rational purpose to our lives. And if that is true, we must be striving towards heaven more than anything else- above all things we see and all things that belong to this world. As St.Paul said ‘ The things we see are ephemeral but the things we do not see are eternal’.