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Wednesday, 13 May 2015

'I Pronounce Him Dead' - The Burden For Doctors

The accident and emergency unit, AnE, of any hospital can be terrifying especially for clinical students. AnE can be said to be synonymous to death, mostly when patients are rushed in from road traffic accidents. It is a horrific site. In one of my posting, as it is on most days, doctors and nurses struggle to save the lives, as many as can be saved. Forms are filled, with EMERGENCY, boldly inscribed on it as it is horridly dispatched to the laboratory. The laboratory know exactly what to do because, they follow precisely what is asked for on the form.

Meanwhile, all efforts back at the AnE, is channeled to save as much as could be saved. The Advanced Trauma Life Support is what is employed in salvaging life in the field. Other principles employed in this instance is the surgical Triage, a colour system where patients are graded according to severity and available resources. It is particularly helpful in multiple trauma situations.

Most times, the efforts of the health staff and the prayers of relative yield results. Under constant monitoring, the patient is watched as he stabilizes, before he is transferred to the main surgical ward for complete recuperation. His place is no more in the AnE ward, a place always in a constant flux.
But at other times, patients are lost. No matter the efforts, the advanced procedures, or even the prayer of relatives, some are lost.

I have always hated this period. Whenever a patient is lost in this way, like in other ways, is not an easy thing to say. To pronounce one dead can be a heavy burden to carry, at least that is how one of my teachers describes it. Some doctors could be in denial state for a long time before coming to terms that truly this one is lost. Doctors would not pronounce a patient dead until some conditions are met. This may include, no pulse, no response in pupillary light reflex, peripheral reflexes are lost, no cardiac activity etc. On satisfying this criteria can the call of death be pronounced and the time of death noted. It is normal practice for the most experienced, most senior doctor to reveal this message to the relatives. It could be sad indeed.

This burden is one that most doctors would agree they do not carry lightly. Most doctors may seem to carry it so well while other know this as a one of their weak points. A lot is expected of doctors but it would not be out of place to know that a doctor bears this unique burden, and daily, it is one too many..