Last Words - An Unfinished Deathbed Talk.


This is an excerpt from the diary entry I made on the morning after a busy duty, a few years back.

I'm about to finish my 24 hours duty. Will have to pull on till Dr X turns up and can return back to my quarters. Yesterday was hectic and not a single minute I could sleep last night. I had 4 patients in the ICU, 53 patients in the ward, 20 new admissions and 7 causality calls. God alone knows, how many hours it's going to take in handing over the previous night to Dr X.
Image courtesy: kevinmd.com

My dear diary, I'm sad. A patient admitted yesterday for close monitoring and evaluation in our FMW is no more. I know, this is not the first time we are losing patients. I have not mentioned about any of them after the first month of my clinical years. But this incident was unique and heart breaking.  

Last night, after my causality call at 12.05 am, I was walking through the corridor of Female Medical Ward (FMW) when I saw light in the last cubical. As I crossed the nursing station, the ward sister woke up from her midnight trance and joined me thinking I was on a midnight rounds.


I kept walking and as I approached closer to the light, I heard somebody singing. Inside, I saw a lady in her late 40s, a patient, sitting on her bed and sewing designs on a piece of cloth and singing lullabies to herself. She was so absorbed at her work that she didn't seem to notice my presence. The nurse was more than happy to leave, when I signaled her to get back to her station.

I stood there for sometime listening and trying to decode her emotions at the same time. She looked worn out and there was some deep rooted sorrow lingering on her face. When I took a closer look, I could see tears running down her cheeks and could hear her weep between the lines she sung.

The moment she sensed my presence, she stopped singing, dropped the cloth on the bed and stood up. Wiping her tears with her pallu she threw a blank, curious stare  at me. I smiled.  "thookkam varamteendhu, athinalathan, koncham neram ethavuthu pudichathu panneetu padukkalam nu irunden. (Didn't feel sleepy. Thought I'll do something I like and then go back to bed)", she said. I smiled again.

I continued to walk until I reached the foot end of the bed and stood there looking at the beautiful embroidery she had being sewing on that kerchief. I picked it up and ran my hand across the design and I complemented her for the work.

For the first time since we met, she smiled and pulled out a chair and offered it to me. After introducing myself, I sat down on the chair and asked her to sit down pointing at her bed. She sat down and picked up the handkerchief and continued her work as we spoke. 

She was Krishnaveni. She was admitted by a colleague of mine for further evaluation of her minor skin disease that kept recurring. She had 3 children all well settled. In few minutes she was comfortable talking to me and started to respond back with a maternal attitude. 

Now, I really cared. I wanted to know what was bothering her. May be I could help her out. Psychologically or otherwise. May be she just needs to vent out her emotions and she may be alright.

I had already identified (unconsciously) her with someone very important in my life. I just experienced the phenomenon of countertransference at its peak. 

I didn't think much. I just put it straight to her. Asked her if there was something that was bothering and if I can help. I left the option open by adding, "if it was too personal you can very well opt not to" . 

She paused for a second and replied, "Thambee, nee yen pulle mathiri. En pullakitte sollame vere yarikkitte nan en kashtathe solrathu? Yarukitteyavuthu pesanal than en manasu sukamayidum nu ninakkarein. En ooru selam. En veetill ungala mathiriye..  (You are like my son. If not to my son who else will I share my difficulties. I need to share this with some one, and I think that will calm me down... My house is in Selam. At home, just like you..)"

The phone in the nursing station rang and the lady briefly paused.  Before she could restart, the ward nurse screamed:  "Sir, there is call from the ICU". "Bed 6- Mr Madhavan-  Post MI has some new ECG changes. In-charge wants you there asap." 

Without wasting any time, I told Krishnaveni that I'll be back in few minutes to listen to her and hurried out of the FMW. Just as I was about to step out, Kishnaveni said,  "Intha kerchief ungalukku. Innum koncham nerathilu ready ayidun. vandu vangittu ponge. (This kerchief is for you.  I'll finish working on it in few minutes. Please do come and collect it later)." I had no time to respond but flashed a brief smile at her and left.
Image courtesy: avikroy.org

I rushed to the ICU pushing open the glass doors. The ICU staff read out the case sheet as I took a look at the ECG monitor. She was excellent at her work. She had already initiated the therapy measures. 

I took over from her and continued with the management. After about 20 minutes, having completed all preliminaries, I gave a call over to the cardiologist and was waiting for the patient to settle down when I got another call from the ward. 

It was the same ward nurse over the phone. " Emergency in last cubical FMW - bed 27- patient collapsed." I handed charge of the ICU patient to the staff and rushed back to the ward. I knew where I had to go. If I'm not wrong it is the same patient, Krishnaveni, who I just met before the ICU call. I was hoping not.

When I reached there, Krishnaveni was already on the resuscitation table gasping for air. With all the gadgets, the pulse oxymeter, the BP cuff, the ECG leads, oxygen mask and 2 IV lines on her, I could hardly look at her. 

I sent a call for the bystanders as the team was put on resuscitation mode. I had the ward sister read out the history and the medication as I promptly initiated C.P.R. "No medicines prescribed yet.  Admitted for observation and evaluation only."  she concluded.

The ward boys rushed in with the crash cart and the staff loaded the syringes and handed over the tray. The technician standing next to me got the DeFib ready. With no delay we sprung into action. 

I knew I had not much of time left. I worked out all the basic life support measures and then moved up to advanced life supports. After few minutes of vigorous try, things were pretty sure, that we were failing. I didn't want to give up. I kept giving her chest compression and breathers. 

As I did, I looked at her face,  the expression of unfinished conversation and the urge to tell me all her sorrows have not vanished yet. I could feel the motherly warmth in her blunt, fixed stare. With every thump I gave, I could sense her receding away from my grip. I started to feel heavy inside me. 

I don't know for how long, but we kept trying. I had forgotten about all the conventional protocols on when to stop hoping and conclude resuscitation. I only had one thing in mind, I  just didn't want to lose her to fate.

The ward sister, tapped on my shoulder and said, " sir, I'm sorry, we have lost her already". I paused for a while. I could feel tear trickle down my face and saw it drop down on her still chest.

Wiping off the sweat from my face with the folded sleeve of my shirt, I took a last look at the lady who just left with a conversation unfinished. In her partly clenched fist was the handkerchief she had been sewing for me. That too left unfinished. 

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74 comments:

  1. We are all helpless when death strikes ultimately...

    I now realize how tough your job is when such heart wrenching incidents occur. I was moved... I wonder what else she would've told you if there was a chance...

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    1. @ Nisha: Thank you. True we are all helpless when death strikes.

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  2. With the memories of passing of my father still green, I know how depressing and traumatising these events can be. That, you being on the other side of the medicinal divide would feel such sorrow at the loss of a 'case', is especially touching.

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    1. @umashankar: I'm sorry for your loss. Either side of the medical divide, we are all the same deep inside. Some express it while others suppress them. May be I'm the first type. Thank you.

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  3. :(
    I feel something, sorry, just can't explain it in words : something terrible!
    never knew words can make me this sad and thoughtful !

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  4. I don't know what to say. This is just so touching. So sad..

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  5. All these are part of our sad and depressing life..! atlease she had a hope in u to share her story! :) a very touching post!

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    1. @Krishnapriya: thank you krishnapriya.

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  6. Death is inevitable and comes uninvited.To be respectful of it and never think of it as something that cannot be coming right now....
    It was a sad blog post..May her soul rest in peace.I dont know what to say but it was very unfortunate.

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    1. @Suzy: Yes it was. really unfortunate. thank you.

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  7. A sensible reconstruction indeed..
    Your lasting impression being shared
    and that too leaves a great respect for the departed nice soul & your humanity..Good wishes.

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    1. @Being_AC: thank you. Glad you like it.

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  8. It's tough being a doctor and dealing with such situations...Sad to hear about the unfinished conversation, I feel poignant after reading it :(

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    1. @Gargi Gupta: It's tough at times. Thank you GG.

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  9. How tough it must be to be a doctor, to see so many patients cling on to you for their life. I can understand the pain and helplessness you must have felt when you knew you were losing her to fate.

    All i can say is I'm sorry for you!

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    1. @Diksha Sharma: Thank you diksha.

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  10. sometimes things are just not in our hand , this reminds me of something I will post on it soon.. there is not much a HUMAN can do then ...

    Bikram's

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    1. @Bikramjit: True. Things are not in our hands at all. I'm looking forward to read your post. Thank you Bikramjit.

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  11. Oh my! So touching. I feel for you, my friend.
    I must say: you did your very best.

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  12. Sometimes destiny confronts us with situations which continue to haunt us!Goes to show that everything is not in human hands!

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    Replies
    1. @ Rahul Bhatia: Yes, Everything is not in our hands. Thank you Rahul.

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  13. Replies
    1. @Aakash Kokz: It is. Thank you Aakash.

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  14. Nothing could be done...
    It had to happen.
    Touched the deepest core of my heart!

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    1. @Red Handed: True red. It had to happen and nothing could be done. Thank you.

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  15. Death waits for no one and no unfinished business matters in the end. Must be something else to witness death so up-close. I have no idea what that feels like really...

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    1. @sumitra: In reality, that is the most unfortunate thing to witness on earth. Thank you Sumitra.

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  16. Sad..:-(
    "only if I could've spent some more time with him/her!"
    don't we feel this at some point or the other??

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    1. @Uma: Yes, that's exactly what I felt then. Thank you.

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  17. So beautiful.... loved reading every bit of this... being a doc is no easy task hats off to you guys . You give us lives:)

    cheers,
    kajal@http://purplechronicle.blogspot.com/

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  18. this was very sad Leo. you tried your level best. it's so hard sometimes

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    1. @Sujatha Sathya: :) Thank you sujatha.

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  19. Everything will not have Happy ending !
    great post
    Dee..

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  20. very very sad. thats the toughest part of being a doctor.
    but then, who can understand it better then doctors that life is but a bubble. has to come to an end sooner or later
    deeply touched.


    sarah

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    1. @subtlescribbler: True, life is a fragile bubble. Thank you Sarah.

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  21. That is so heart breaking. I have lost a loved one too, I know how it feels. I really applaud your genuine efforts. It was heart touching. :'(

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    1. @Akshay Kumar G: Thank you Akshay.

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  22. Beautifully written. I witnessed a dear friend die exactly my this; he was young at that time. Suddenly, after trying to revive him when the head doctor said, "We can stop now"; it hit me hard that I witnessed a friend dying. I guess a doctor has to be less emotional because he sees it often.

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    1. @sunbyanyname: yes, doctors see death more often. but things like this don't happen usually. Thank you.

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  23. Omg! Its so disheartening to hear you actually witnessed death on full scale.

    Yet,so beautifully written!

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    1. @Jen..The Butterfly Effect: Thank you Jen.

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  24. Extremely well written. I wish more Doctors blogged.

    I have written only 1 post on matters related to medicine and perhaps some patient of yours might benefit from it. It is on 'Fighting Stage IV Cancer' and can be found on my serious blog:
    http://satish-botheyeswideopen.blogspot.com/

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    1. @Satish Mutatkar: Thank you Satish.

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    2. I've already read that post.

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  25. Replies
    1. @Neeraj Kumar: I dont have an answer. Thank you Neeraj.

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  26. We need immense courage to face the ultimate eventuality - even when we know we all have a return ticket!
    The diary entry is so very palpable- poignant!

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    1. @specs buffy: True. Thank you Sunita.

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  27. For some moments in life there are no words.

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  28. Replies
    1. @Abhyudaya Shrivastava: Thank you Abhyudaya.

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  29. Oh! Sometimes we feel helpless...worst thing is we can't reverse time.
    A very heartfelt incident.

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  30. Oh Doc ! you are making me sad now :(
    Wonderful narration and expression of feelings.Wish we could control LIFE.

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  31. sir..its really touching... :(

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  32. Hey keep posting such good and meaningful articles.

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  33. What you're saying is completely true. I know that everybody must say the same thing, but I just think that you put it in a way that everyone can understand. I'm sure you'll reach so many people with what you've got to say.

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  34. very informative post for me as I am always looking for new content that can help me and my knowledge grow better.

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  35. Blogging is the new poetry. I find it wonderful and amazing in many ways.

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  36. Nice post, things explained in details. Thank You.

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