12 June 2013

Death and disease

Note: This post describes a patient's death. It has content that many would find graphic and upsetting. Please use discretion.

I burst into the operating room to find an unsettled scene. A crush of surgeons were hurriedly incising the patient's leg around its circumference. Catching glimpses of the patient as I peeked around surgeons' shoulders and arms, I noticed that the surgical field was a tangled mess of arteries and muscles. I couldn't find enough anatomical landmarks to orient myself, because the tissue had turned into an eerie purple mush. I didn't know where in the leg we were cutting or why. I glanced at the knee and the foot. They looked bloated and dusky.

Eventually, I spotted an ivory gleam: the head of the patient's femur. I finally inferred what the surgical team was up to: they were hurriedly amputating the patient's leg, tugging the femur out of the hip socket. The patient had necrotizing soft tissue infection, what is popularly called "flesh-eating bacteria". The team was furiously trying to outpace the fast-advancing infection that was dissolving the patient's soft tissues. Blood had flecked onto one of the surgeon's cheeks. Other surgeons were standing in a giant puddle of blood that had formed on the floor. None seemed to care.

When the amputation was complete, the team looked dejected. The lead surgeon fretted that the infection had spread already throughout the patient's body. I left the operating room to check on a patient in the emergency room. When I returned half an hour later, the scene was even more harrowing than before. We debrided (removed dead tissue from) the patient's back and neck, trying vainly to remove the decaying muscles and turn back the tide. Everywhere I looked there was decomposing tissue. "Look over there!" one of the residents gestured. "That patch of muscle looked totally fine 15 minutes ago." Sure enough, the swath of muscle he was pointing to was dead. The parts of the body that we hadn't incised were becoming bloated with gas. The infection was overtaking the patient before our eyes. With a leaden voice, the lead surgeon "called" the case. Surgery could not save our patient. Nothing could. "Don't order any more labs, no more medications except for pain relief," the surgeon called out to the bewildered anesthesiologists. "Comfort care only."

Now our task was to stop the bleeding. We worked just as earnestly as before, hurrying to give the family a chance to the see the patient before the clock ran out. I packed one of the incision sites with absorbent sponges. One of the surgeons must have realized that I couldn't discern what part of the body I was working on. He tapped on an exposed bone nearby. "This is the scapula," he said.

Not very long after, the family's piercing cries of grief echoed through the deserted halls of the surgical wing. It was a shock. The patient had been healthy not even 24 hours before.

A particularly cruel infection killed this patient, an alien invader that destroyed with unfathomable speed and ferocity.

I thought of Dr. Rieux, the protagonist of Camus's The Plague. "What I hate is death and disease," Rieux says. So do I. I hate them more than anything.