I felt relaxed and happy after nice long lunch in sunny San Diego – the Senior Ship’s Physician. I passed through the infirmary on the way to my cabin, just checking in. Describing shock in idiom – ‘then it hit me’, ‘bowled me over’, ‘taken aback’ – had never held meaning for me until I walked through that door.
I saw stars as blood drained from me; beyond them, through the door into our resus bay, my friend blue, with sats in the mid-sixties. It felt like I’d been hit with a sandbag. I rocked backwards. Time slowed, voices buzzed like angry bees in a tin. I could hear my normally unflappable Lead Nurse more accustomed to trauma in the Cape Townships than sea sickness and indigestion, whispering under her breath ‘I killed him; I killed him; I killed him’; a mantra through a copper speaking tube. Her face mirrored mine: terror, confusion, frozen in a prison of helplessness.
It was seconds. Or a lifetime. Numbly, I registered my friend’s wife. It was her pleading look that tore me from my own gravity well. My first experience of another idiom: I pulled myself together. I resutured the jagged shards of my shattered thoughts, concentrated on my own breath. I forced myself to walk, one foot in front of the other. As I edged unsteadily forward in to the resus bay, I saw another face. The other doctor. Quiet and competent, resuscitating my friend. Relief, like a warm waterfall, weight off my chest. And with that, sense and sensibility returned. Gratitude I could be a friend and not a doctor.
I have thought of that day often. The lesson I learnt. You can’t care for the people you care for.
He nearly died. Accidental contamination of his food with a fish product. In a different month (when I was the only doctor aboard), he might have. Would I have been able to pull myself out of my fugue?
My Lead Nurse’s judgement had been impaired. Her friend dying, and no other medical practitioner to hand, she had given adrenaline 1:1000 IV, shortly before the doctor’s arrival. But at least she had done something. I suspect, being a fit athletic Russian dancer, he could tolerate the heart rate of a humming bird for a few minutes, and on reflection, his saturations might have something to do with him being so vasoconstricted he had to wear woollies in the Mexican Riviera for the next week.
I take the lesson to heart. We all care; we do. But we can’t do the job unless we are professional and a little distant. I take care to challenge myself more when I ‘like’ a patient: Am I doing it because it is right, or because I like them?
And I remind myself, in times of crisis, of the third law of the House of God: at a cardiac arrest, the first procedure is to take your own pulse.
Dr Dominic Hennessy is a GP in Dorset
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