In The Deep End

Today was my 3rd ED shift. And it was the most challenging 7 hours of my life. 

Mostly because of just 1 patient. 

At the beginning of the shift, my consultant was called to resus to see a 15 year old boy who had come in with 5 days of headache but who had since become unconscious in the resus area. 

He had no other medical conditions. The whole team was working on making him regain consciousness. While differentials such as meningitis and seizures crossed everyone’s mind. 

The mother came in shortly afterwards frightened and distressed as she recounted how he had had only a headache for the last 5 days but today while she was at work, had called and said bizarre things before hanging up. She returned home to find him unsteady on his feet before collapsing to the ground. The mother also brought her 4 year old son with her. There was no father to be seen. 

The young boy regained some consciousness. He was responsive to speech and followed commands. Everyone became confident at this improvement. My consultant decided now would be a good time to CT scan his head for signs of infection or bleed. 

The boy was wheeled off and my consultant and I followed him. 

The CT scan showed a large tumour pressing on the boy’s brain. Causing the brain to be pushed to one side, likely resulting in this symptoms. He would have a large amount of pressure in his skull at that time. 

The consultant took the mother into a room to talk to her. I was present when he told her the news. 

She instantly burst into tears and wailed. Her precious, obedient, healthy boy was going to be taken from her? How could this happen? Will he be cured?

My consultant told her that he would contact the neurosurgeons who would tell her more about the next steps in management. 

She cried harder. She told us she had no one else. That the boy’s father was estranged from when he was 4 years old. That the boy was all she had. 

He younger son was oblivious to what was going on as he quietly played with some puzzles. 

Meanwhile we were again called to resus as the boy had lost consciousness again and was now showing signs of very high pressures in his skull. One of his pupils were dilated massively while the other was small. The neurosurgeons arrived to take him to theatre immediately and they began to put a tube down his throat as he was no longer breathing on his own. 

At this point, the consultant asked me to sit with the mother. And console her and prevent her from witnessing the placement of the tube. 

I was way out of my depth. The mother begged me to be with her son. She asked me whether she had given him some food that may have caused the tumour. Or whether a fall as a young child would have caused it. She told me she worked so hard and had saved money for a house for him in the future. How he had wanted to be a pilot when he was older and how she had arranged classes for him to learn more about this every week. 

She asked me if he could be cured. Or if he was going to die in ICU where he would be taken after the neurosurgeons performed an emergency operation to relieve the pressure in his brain. 

I comforted her as best as I could. Telling her she couldn’t have prevented any of this. That some things just happen. She asked me why God was taking her son away from her. I had no answer. She said she had been a bad mother. 

She eventually decided to call the boy’s father as he was taken to surgery. 

To complicate matters further, the father began yelling at the mother. Saying it was her fault he had gotten cancer. 

This carried on to the point where my consultant had to intervene to explain to him that it was no one’s fault. 

The boy’s father said his nephew also had brain tumour but he’s fine now. 

The mother, who was hurting in a big way, clearly fed up with the father’s accusations said that she was the best mum in the world for her son. And that if cancer ran in the father’s side of the family, he should have mentioned it earlier. 

It was all rather weird for me. 

But it was just

Quite confronting. 

I’ve never seen such a situation before. The reality of what happens if medicine isn’t good enough. And sometimes it just isn’t good enough to answer every question or solve every problem. And what that leaves behind is quite devastating. 

I couldn’t process everything for a while. My consultant asked if I needed a break to calm down. 

How did I react to this? I said I didn’t require a break. I just need to go see the next patient. 

I can’t say why I said that. I guess I needed to feel like even though it was obvious that not much could be done for that young boy, much could be done for other patients. And I needed to see that. And I needed to be part of that. To get over the disappointment and the grief that I had witnessed. 

It all just goes back to what Robert Frost had said:

“I can sum up everything I have learnt about life in 3 words:”

It Goes On…..

I guess I have to also be grateful for my life and my health. And the health of those closest to me. It shouldn’t ever be taken for granted