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.