Tug of war

On Friday I spent the afternoon in a tug of war. On one side were me and my colleagues and on the other was whatever happens after you die. The Light, heaven, hell, nothing, I don’t know? I just know that it was a tug of war between life and death, and life lost.

In the middle was my patient, a lady in her forties, a mother, a sister, with coronavirus. Her lungs were filled with fluid, like a saturated sponge, with no room for air. The life-saving high-flow oxygen machine that you’ve probably read about in the media was not enough for her. She was getting tired. Her heart was tired. Trying to fill a wet sponge with air takes a lot of energy. She needed to be intubated and ventilated. She needed me to put a tube in her throat and through her vocal chords (intubate) and connect her to a machine that would breathe for her (ventilate).

But her body couldn’t handle it and her heart gave up. When we intubate someone they need to be paralyzed. We give them medication to sedate them and to turn off every muscle in the body, including the ones that draw air in and out of the lungs. Once this medication is given a tense few minutes follow. Everyone holds their breath with the patient. The tube going into the lungs is now that person’s only hope at getting oxygen into their body. The holder of that tube, in this case, me, literally holds that person’s life in their hands. So much can go wrong. If the tube goes down the wrong way, you will give oxygen into the stomach instead of the lungs. Put the tube in too deep and you will only aerate one lung instead of two. If the vocal chords spasm, you cannot get the tube in at all. The medications that we use can cause a drop in blood pressure, allergic reactions or the heart to beat abnormally. Or the body can just simply not have enough reserve to withstand this risky, but life-saving, procedure. With coronavirus, this is usually the.

Her heart gave up and we started CPR. Her heart started beating again. Then it stopped again. We started CPR again. We got her back. This went on for over an hour. A tug of war.

Witnessing death is never easy. No matter how many times I am involved in a resuscitation that fails, no matter how many time-of-deaths I call, no matter how many death notifications I fill in. No matter the circumstances, I always have the same questions.

If the purpose of medicine is to heal; to guide people away from death, does that mean medicine has failed when someone dies?

Did my actions start the tug of war?

Did the intubation process kill her or did coronavirus kill her?

If we hadn’t done anything would she have died anyway? Would the tug of war have started anyway? Was I merely an accomplice?

What about her family? What about her children? Do they now feel the way I imagine I would feel if my mother died? Did they wake up this morning with broken hearts and crushed worlds?

Could things have been different?

Maybe we could have saved her?

Maybe if we had intubated sooner? Maybe if it hadn’t taken three hours to find her an ICU bed? Maybe if all the ICUs in Cape Town were not full?

Maybe if coronavirus wasn’t a thing? Maybe if the world took this ‘thing’ more seriously?

Maybe then we could have saved her?

But we couldn’t.

And coronavirus is a thing.

And she died.

And so did 11 135 other people around the world.

And the tug of war continues.

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