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My Night on Call…Life and death decisions

Authors: Fatima Rauf, Rawalpindi, Pakistan, @fatimarauf45

“Critical event: The patient collapsed. CPR done, but could not be revived. ECG showed a straight line. Death declared.” 

Reading this update about a patient in our surgical WhatsApp group made my heart sink. Everything became blur, and all questions seemed unanswered. My mind wandered thinking of all the possibilities that could have prevented this death. 

I still remember this patient coming to the outpatient department for stoma reversal. Two years ago he had surgery for an intussusception, a polyp being the leading point. He was diagnosed with Peutz-Jeghers syndrome – a disease that affected about 80% of his family. I admitted him for the reversal of his stoma, and I remember being scrubbed in for his surgery. The moment, we entered the abdomen, we were in trouble. After hours of careful adhesiolysis, we finally managed to finish the surgery. Because of the friability of his gut, he developed multiple entero-cutaneous fistulas. He remained in hospital for about two months and was managed conservatively. He gradually improved and was finally discharged. He fought his disease bravely. The whole surgical team worked tirelessly for him, and watching him fight so bravely gave us even more courage and hope.

About two weeks ago, I heard through a WhatsApp group update (I was on my elective surgical speciality rotation) that he was again admitted because of a high output fistula and dehydration and after further surgery, he did not recover, and died. 

All of this made me think of all the other possibilities. If he had not chosen to have his stoma reversed, things would have been different. I concluded that after this decision, a courageous soul left this earth after a long battle. I won’t say he lost. I won’t say his doctors lost. It was just that death won in the end. 


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